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Study: Magnesium sulfate cuts risk of CP in preemies

March 26th, 2008

From USATODAY.com

Giving a cheap and widely available drug to pregnant women at high risk of premature delivery cut the risk of cerebral palsy in their babies by nearly half, according to a study presented Thursday.

Premature babies are at high risk for cerebral palsy, an often devastating movement disorder caused by brain damage before, during or after birth, says study co-author John Thorp, a professor at the University of North Carolina at Chapel Hill. About one-third of cerebral palsy cases are caused by early preterm birth, he says.

Giving magnesium sulfate, or Epsom salt, could save many children from the condition, Thorp says. Doctors regularly use the drug to halt contractions when women go into labor very early. The drug is found in virtually every labor and delivery department and costs just pennies a dose, he says.

In Thorp’s study, presented at the Society for Maternal-Fetal Medicine annual meeting in Dallas, doctors focused on 2,241 women whose water broke very early

between the 24th and 31st weeks of pregnancy. A full-term delivery occurs after at least 37 weeks.

Doctors randomly assigned some women to get intravenous magnesium sulfate and others to get a placebo, a study design that’s considered the “gold standard” of medical testing.

About 1.9% of women on magnesium sulfate had babies with moderate or severe cerebral palsy, compared to 3.5% of women who didn’t get the drug, the study shows. The drug caused no serious side effects, although more women taking magnesium sulfate felt flushed or sweaty. Some reported temporarily blurred vision.

“This is a real breakthrough,” says Thorp, noting that his study is especially powerful because it confirms the findings of a 2003 Australian study. “These are children who have their whole lives in front of them.”

About 2 or 3 children in 1,000 over the age of 3 are diagnosed with cerebral palsy every year, says Dara Richardson-Heron, national medical director of United Cerebral Palsy, which wasn’t involved in the study. She called the study “very promising.”

Margarita de Veciana, a maternal-fetal medicine specialist at Eastern Virginia Medical School in Norfolk, Va., says Thorp’s study is likely to spark a debate.

Some doctors are now using drugs other than magnesium sulfate to prevent preterm labor, de Veciana says, because studies haven’t shown that magnesium sulfate works as well as previously believed. Doctors may reconsider abandoning magnesium sulfate, however, if it can prevent disabilities.

“This could have a huge impact,” de Veciana says.

Geeta Swamy, a maternal-fetal medicine specialist and assistant professor at Duke University Medical Center, says Thorp’s study isn’t likely to change the way women are treated right away.

Although the drug caused no serious problems in Thorp’s study, Swamy says a handful of women each year do have bad reactions to magnesium sulfate, which can sometimes cause respiratory problems. Doctors will want to scrutinize Thorp’s data to decide if the drug’s benefits outweigh its risks.

“This study has the potential to change practice, but we don’t have enough information yet,” Swamy says.

Treating Cerebral Palsy with Hyperbaric Oxygen Therapy

February 17th, 2007

The term cerebral palsy is not a specific diagnosis, but is now generally applied to children who experience some form of brain trauma either at the time of birth or shortly before. Most commonly these children manifest some degree of cognitive dysfunction along with physical impairment, often weakness and spasticity of arms and legs.Treatment approaches for children with cerebral palsy (C.P.) are generally directed at the manifestations of the underlying brain disorder. That is, most efforts are geared to increasing range of motion, reducing spasticity, and increasing strength, along with specific therapies designed to enhance skills of communication and academic performance.

As in stroke and head injury, the damaged areas of the brain in cerebral palsy do not exist in sharp contrast to regions of completely normal function. Rather, between these two extremes there exists a population of neurons that while alive, are not functioning at optimum capacity. It is these idling neurons that respond to hyperbaric oxygen therapy (HBOT).

Hyperbaric oxygen therapy is an exciting medical treatment approved by the FDA and AMA which enhances tissue levels of life giving oxygen. Normally, oxygen is almost exclusively carried by red blood cells. During HBO therapy, there is a substantial increase in the amount of oxygen carried in all body fluids including plasma, cerebrospinal fluid, lymph, and intracellular fluids. This allows increased oxygen levels even in areas with poor or compromised blood supply as well as in areas of tissuedamage. Increasing tissue oxygen levels produces several important long term therapeutic benefits including enhanced growth of new blood vessels, increased ability of white blood cells to destroy bacteria and remove toxins, increase growth of fibroblasts (cells involved in wound healing), and enhanced metabolic activity of previously marginally functioning cells including brain neurons. Patients receiving hyperbaric oxygen therapy are treated in a chamber where they breathe 100% oxygen delivered to the chamber under increased pressure. During the treatments, which typically last 1 to 2 hours, patients relax, watch television, or sleep while they are carefully monitored by highly trained technicians with whom they can communicate easily through an intercom system.

Evidence accumulating from around the globe is now providing strong support for the use of HBOT as an approach to the actual functional problem in children with cerebral palsy

a technique that targets marginally functioning brain tissue. Encouraging research is taking place in Canada where Dr. Pierre Marois and his team of researchers at McGill University in Montreal have recently studied 25 children with cerebral palsy, aged 4 to 7 years, treated with hyperbaric oxygen therapy on a daily basis for 20 days. Another 15 children were treated twice a day for 10 days. Both groups thus received a total of 20 treatment sessions. The results of their post-treatment evaluations were truly remarkable. According to Dr. Marois: the results are really incredible! Twenty-three of the 25 children have great results. Twenty-three have amelioration with their spasticity and may have amelioration with speech and cognitive function. Further, their published results reveal the clinical observations do list numerous functional changes, definite improvements, a large amount in the level of arousal/response to communication. From statistical analysis of the objective estimations we confirm these change, more particularly on the level of motor functioning like walking and the quality of sitting position, similarly on the level of spasticity. These results are surprising considering the small number of treatments (20), and of extreme importance because its the first study documenting objectively the prospects of beneficial effects of HBO in the treatment of children suffering from cerebral palsy. Marois, P., The Pilot Project on Treatment in Hyperbaric Oxygen Therapy

While it is important to recognize that hyperbaric oxygen therapy clearly represents an important tool in the treatment of children with cerebral palsy, it should be viewed as an adjunctive form of therapy to be used in conjunction with other established treatment protocols including physical therapy, occupational therapy, speech therapy, as well as pharmaceutical therapy designed to reduce spasticity. The use of HBO in children with cerebral palsy is now gaining a strong foothold in the United States and there is no doubt that because of its profound effects, its utilization will become much more widespread.

Public awareness of the use of hyperbaric oxygen therapy in children with cerebral palsy in North America can be credited in large part to the work done by Mothers United for Moral Support (MUMS). This worldwide organization, founded by Julie Gordon, a mother of a child with cerebral palsy, seeks to unite parents of children with cerebral palsy and other needs and to share information concerning various therapeutic options. They can by contacted by telephone at 920-336-5333, or visit their web site:

MUMS Home Page