Can hypomagnesemia cause seizures?

From the Guidelines

Yes, hypomagnesemia can cause seizures, as it plays a crucial role in neurological function and its deficiency can lead to neurological symptoms, including seizures. According to the most recent study 1, hypomagnesemia, generally defined as serum magnesium levels <0.70 mmol/l, has been reported in up to 12% of hospitalized patients, with an incidence around 60-65% among critically ill patients. This study highlights the importance of monitoring and managing electrolyte abnormalities, including hypomagnesemia, in hospitalized patients, especially those undergoing kidney replacement therapy (KRT).

Key Points to Consider

• Hypomagnesemia can occur due to various reasons, including kidney failure, malabsorption disorders, and certain medications, and can lead to severe complications, including seizures 1.
• The study 1 emphasizes the need for preventing electrolyte disorders during KRT by using dialysis solutions containing potassium, phosphate, and magnesium.
• Treatment of hypomagnesemia involves magnesium replacement, typically with magnesium sulfate, and oral supplementation with magnesium oxide or magnesium citrate for less severe cases or maintenance therapy.
• It is essential to monitor patients at higher risk of hypomagnesemia, such as those with malabsorption disorders, alcoholism, or chronic diarrhea, and to prevent hypomagnesemia by modulating KRT fluid composition 1.

Management and Prevention

• The use of dialysis and replacement fluids with increased magnesium concentration may be indicated to prevent KRT-related hypomagnesemia 1.
• Intravenous magnesium sulfate at 2-4 grams over 15-20 minutes can be administered for acute seizures due to hypomagnesemia, followed by maintenance dosing of 1-2 grams per hour until levels normalize.
• Oral supplementation with magnesium oxide (400-800 mg daily) or magnesium citrate (200-400 mg daily) can be used for less severe cases or maintenance therapy.

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.

Hypomagnesemia and Seizures:

• Hypomagnesemia can cause neurological symptoms such as muscle irritability, clonic twitching, and tremors.
• Magnesium plays a crucial role in preventing or controlling convulsions by blocking neuromuscular transmission.
• The FDA drug label suggests that magnesium can be used to control seizures associated with various conditions, including epilepsy and hypothyroidism.
• Therefore, it can be inferred that low magnesium levels (hypomagnesemia) can contribute to the development of seizures 2, 2.

From the Research

Hypomagnesemia and Seizures

• Hypomagnesemia, or low magnesium levels, has been linked to an increased risk of seizures in various studies 3, 4, 5, 6.
• 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.
• Research suggests that magnesium deficiency can decrease seizure thresholds in animal models of epilepsy and that low magnesium concentrations 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 3.
• A study published in the Journal of Neurology found that magnesium deficiency can cause acute intractable seizures, highlighting the importance of recognizing hypomagnesemia in patients with seizures 4.
• Another study published in Cureus reported a case of proton pump inhibitor-induced hypomagnesemia causing seizures, emphasizing the need to assess for electrolyte abnormalities in patients with neurological symptoms 5.

Epidemiological Studies

• A study published in BMC Pediatrics found that hypomagnesemia was more common in children with febrile seizures than in controls, and that low serum ionized magnesium levels were an independent risk factor for febrile seizure 6.
• The study suggested that serum ionized magnesium levels < 0.51 mmol/L could predict the presence of febrile seizures with a sensitivity of 45.1% and a specificity of 92.6% 6.
• However, further evidence is needed to establish a causal relationship between low magnesium and febrile convulsions 6.

Magnesium Supplementation

• Some studies have suggested that magnesium supplementation may be beneficial in reducing seizures in people with epilepsy 3, 7.
• However, more research is needed to fully understand the potential role of magnesium deficiency as a causal factor in epilepsy and to determine the efficacy of magnesium supplementation in preventing seizures 7.