Abstract

Background: Traumatic brain injury (TBI) in Nigeria is associated with substantial morbidity and mortality and reduced brain magnesium levels. MST has been proposed as a neuroprotective intervention, although evidence supporting its benefit in severe TBI remains unpredictable.
Objectives: This study aimed to assess the effect of MST on clinical outcomes and seizure occurrence among patients with severe TBI and hypomagnesaemia.
Methods: In this prospective, randomized, double-blind trial, using computer-generated randomization and sealed envelopes, 50 patients with severe TBI and low serum magnesium levels were assigned to receive either magnesium sulfate plus standard care or standard care alone. Seizure frequency (early and late post-traumatic seizures) and functional status at 8 weeks post-injury were the primary outcomes.
Results: Early seizures occurred in 16.0% of the MST group versus 28% of the controls, while late seizures occurred in 4.0% and 8% of the controls; these differences were not statistically significant (p = 0.496 and p = 0.189, respectively). However, at 8 weeks, significantly more patients receiving MST achieved favorable neurological outcomes (60.0% vs. 12.0%; RR = 5.00; ARR = 0.48; NNT = 2.1; p = 0.001). Older age was significantly associated with poorer outcomes.
Conclusion: MST significantly improved functional recovery at 8 weeks of age, whereas increasing age predicted a worse prognosis.

Key words: Glasgow Outcome Score, Magnesium sulfate, severe head injury, seizure