From the Guidelines
Low magnesium levels can trigger seizures, as evidenced by the association between hypomagnesemia and seizure activity in various clinical contexts. Magnesium plays a crucial role in neurological function by regulating neurotransmitter release and blocking certain receptors in the brain that, when overactive, can lead to seizure activity. When magnesium levels fall below normal, the brain becomes more excitable, potentially resulting in seizures. Hypomagnesemia-induced seizures may occur alongside other symptoms like muscle cramps, tremors, and irregular heartbeat.
Key Points to Consider
- Hypomagnesemia can cause significant neurological symptoms, including seizures, as noted in a study on delirium in adult cancer patients 1.
- Seizures can be a manifestation of various underlying conditions, including hypomagnesemia, as highlighted in a study on 22q11.2 deletion syndrome 1.
- Treatment of hypomagnesemia-induced seizures involves magnesium supplementation, usually with magnesium sulfate or magnesium oxide.
- Addressing the underlying cause of magnesium deficiency is essential, whether it's related to poor dietary intake, certain medications, alcoholism, or gastrointestinal disorders that affect absorption.
- Intravenous magnesium sulfate may be administered at 1-2 grams over 5-10 minutes, followed by continuous infusion, for severe cases with active seizures.
Management and Prevention
- For prevention and maintenance, oral supplements like magnesium oxide (400-800 mg daily) can be effective.
- Periodic neurologic enquiry/assessments should be considered for seizures/seizure-like episodes, supplemented by standardized rating scales and ancillary procedures.
- Collaboration with a specialist, such as an epileptologist or movement disorders neurologist, is recommended for patients with suggestive features.
From the FDA Drug Label
As a nutritional adjunct in hyperalimentation, the precise mechanism of action for magnesium is uncertain. Early symptoms of hypomagnesemia (less than 1. 5 mEq/L) may develop as early as three to four days or within weeks. Predominant deficiency effects are neurological, e.g., muscle irritability, clonic twitching and tremors. Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing the amount of acetylcholine liberated at the end-plate by the motor nerve impulse.
Low magnesium levels can trigger seizures. The drug label states that magnesium prevents or controls convulsions, implying that a lack of magnesium can lead to seizures. Additionally, the label mentions that early symptoms of hypomagnesemia include neurological effects such as muscle irritability, clonic twitching, and tremors, which can be precursors to seizures. 2
From the Research
Low Magnesium and Seizure Risk
- Low magnesium levels have been associated with an increased risk of seizures in various studies 3, 4, 5.
- Magnesium plays a crucial role in many cellular functions, including oxidative phosphorylation, glycolysis, DNA transcription, and protein synthesis, and its deficiency can lead to a range of medical conditions 3, 6.
- Research suggests that magnesium deficiency can decrease seizure thresholds in animal models of epilepsy and can generate spontaneous epileptiform discharges from rat hippocampal slices 3.
Clinical Evidence
- Case reports have shown that seizures can be controlled with magnesium supplementation in people with specific conditions, such as infantile spasms and eclampsia 3, 5.
- A retrospective chart review of 22 cases of drug-resistant epilepsy found that oral magnesium supplementation was associated with a significant decrease in the number of seizure days per month 7.
- Another study found that maintaining a magnesium level >0.65 mmol/L improved or eliminated seizures in patients with hypomagnesemia-associated seizures 4.