Efficacy of oral magnesium therapy in the treatment of chronic constipation in spastic cerebral palsy children: a randomized controlled trial

Abstract

Background

Constipation is a common problem in children with spastic cerebral palsy (sCP) with a prevalence that reaches 75%. We hypothesized that treating constipation in those children will improve their health and shorten time spent in daily care. Our aim was to evaluate the efficacy and safety of oral magnesium sulfate for treating chronic constipation in children with sCP.

Methods

A prospective, double-blinded randomized control trial was carried out involving 100 children aged 2–12 years with sCP (level III–V of the Gross Motor Functional Classification system) and chronic constipation. They were followed up in the Pediatric neurology clinic, Children’s hospital, Ain Shams University, May 2017- January 2019. The intervention group (O–Mg) received oral magnesium sulfate 1 mL/kg/day daily for 1 month compared to the placebo. Outcome measures were constipation improvement and decrease in bowel evacuation time after 1 month.

Results

Initially, weekly bowel movements, constipation scores and stool consistency were comparable in both groups. After 1 month of regular administration of oral magnesium sulfate, the constipation score, stool frequency and consistency improved compared to the placebo group (P < 0.001). Effective safe treatment was achieved in 31 (68%) and 4 (9.5%) patients in the O–Mg and placebo groups, respectively (RR, 2.95; 95% CI 2.0–4.5) (P < 0.001). Painful bowel evacuation attempts spent by mothers decreased from 25 (55.6%) of the cases initially to 10 (22%) cases after one month in the O–Mg group (P = 0.001). In contrast, in the placebo group, the decrease went from 21 (50%) cases initially to 18 (42.9%) after 1 month and was not significant (P = 0.5).

Conclusions

Oral magnesium sulfate seems effective in alleviating chronic constipation and pain experience in children with sCP. Consequently, saving maternal time spent in daily bowel evacuation attempts.

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References

  1. 1.

    Abas O, Abdelaziem F, Kilany A. Clinical spectrum of cerebral palsy and associated disability in south egypt: a local survey study. Open Access Maced J Med Sci. 2017;5:37–41.

    Article  Google Scholar 

  2. 2.

    El-Tallawy HN, Farghaly WM, Shehata GA, Rageh TA, Metwally NA, Badry R, et al. Cerebral palsy in Al-Quseir City, Egypt: prevalence, subtypes, and risk factors. Neuropsychiatr Dis Treat. 2014;10:1267–72.

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Hassanein SM, Deifalla SM, El-Houssinie M, Mokbel SA. Safety and efficacy of cerebrolysin in infants with communication defects due to severe perinatal brain insult: a randomized controlled clinical trial. J ClinNeurol. 2016;12:79–84.

    Google Scholar 

  4. 4.

    Bhatia M, Joseph B. Rehabilitation of cerebral palsy in a developing country: the need for comprehensive assessment. Pediatr Rehabil. 2000;4:83–6.

    CAS  PubMed  Google Scholar 

  5. 5.

    Veugelers R, Benninga MA, Calis EA, Willemsen SP, Evenhuis H, Tibboel D, et al. Prevalence and clinical presentation of constipation in children with severe generalized cerebral palsy. Dev Med Child Neurol. 2010;52:e216–21.

    Article  Google Scholar 

  6. 6.

    Ferreira A, Mayer MPA, Kawamoto D, Santos M. Constipation, antiepileptic drugs, and gingivitis in children and adolescents with cerebral palsy. Int J Paediatr Dent. 2019;29:635–41.

    Article  Google Scholar 

  7. 7.

    Park ES, Park CI, Cho SR, Na SI, Cho YS. Colonic transit time and constipation in children with spastic cerebral palsy. Arch Phys Med Rehabil. 2004;85:453–6.

    Article  Google Scholar 

  8. 8.

    Hyams J, Colletti R, Faure C, Gabriel-Martinez E, Maffei HV, Morais MB, et al. Functional gastrointestinal disorders: working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2002;35(Suppl 2):S110–7.

    Article  Google Scholar 

  9. 9.

    Kokkonen J, Haapalahti M, Tikkanen S, Karttunen R, Savilahti E. Gastrointestinal complaints and diagnosis in children: a population-based study. Acta Paediatr. 2004;93:880–6.

    CAS  Article  Google Scholar 

  10. 10.

    Rivi E, Filippi M, Fornasari E, Mascia MT, Ferrari A, Costi S. Effectiveness of standing frame on constipation in children with cerebral palsy: a single-subject study. OccupTherInt. 2014;21:115–23.

    Google Scholar 

  11. 11.

    Rossier P, van Erven S, Wade DT. The effect of magnesium oral therapy on spasticity in a patient with multiple sclerosis. Eur J Neurol. 2000;7:741–4.

    CAS  Article  Google Scholar 

  12. 12.

    Chen HY, Cheng FC, Pan HC, Hsu JC, Wang MF. Magnesium enhances exercise performance via increasing glucose availability in the blood, muscle, and brain during exercise. PLoS ONE. 2014;9:e85486.

    Article  Google Scholar 

  13. 13.

    Sun Q, Weinger JG, Mao F, Liu G. Regulation of structural and functional synapse density by L-threonate through modulation of intraneuronal magnesium concentration. Neuropharmacology. 2016;108:426–39.

    CAS  Article  Google Scholar 

  14. 14.

    Na HS, Lee JH, Hwang JY, Ryu JH, Han SH, Jeon YT, et al. Effects of magnesium sulphate on intraoperative neuromuscular blocking agent requirements and postoperative analgesia in children with cerebral palsy. Br J Anaesth. 2010;104:344–50.

    CAS  Article  Google Scholar 

  15. 15.

    Ramkumar D, Rao SS. Efficacy and safety of traditional medical therapies for chronic constipation: systematic review. Am J Gastroenterol. 2005;100:936–71.

    Article  Google Scholar 

  16. 16.

    Tanaka K, Miyake Y, Sasaki S, Ohya Y, Miyamoto S, Matsunaga I, et al. Magnesium intake is inversely associated with the prevalence of tooth loss in Japanese pregnant women: the Osaka Maternal and Child Health Study. Magnes Res. 2006;19:268–75.

    CAS  PubMed  Google Scholar 

  17. 17.

    Tabbers MM, DiLorenzo C, Berger MY, Faure C, Langendam MW, Nurko S, et al. Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr. 2014;58:258–74.

    CAS  Article  Google Scholar 

  18. 18.

    Institute of Medicine (US) Standing committee on the scientific evaluation of dietary reference intakes. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and Fluoride. Washington (DC): National Academies Press (US); 1997. PMID: 23115811. 

  19. 19.

    Dupont C, Campagne A, Constant F. Efficacy and safety of a magnesium sulfate-rich natural mineral water for patients with functional constipation. Clin Gastroenterol Hepatol. 2014;2:1280–7.

    Article  Google Scholar 

  20. 20.

    Mori H, Suzuki H, Hirai Y, Okuzawa A, Kayashima A, Kubosawa Y, et al. Clinical features of hypermagnesemia in patients with functional constipation taking daily magnesium oxide. J Clin Biochem Nutr. 2019;65:76–81.

    CAS  Article  Google Scholar 

  21. 21.

    Tatsuki M, Miyazawa R, Tomomasa T, Ishige T, Nakazawa T, Arakawa H. Serum magnesium concentration in children with functional constipation treated with magnesium oxide. World J Gastroenterol. 2011;17:779–83.

    CAS  Article  Google Scholar 

  22. 22.

    Bothe G, Coh A, Auinger A. Efficacy and safety of a natural mineral water rich in magnesium and sulphate for bowel function: a double-blind, randomized, placebo-controlled study. Eur J Nutr. 2017;56:491–9.

    CAS  Article  Google Scholar 

  23. 23.

    Vu MK, Nouwens MA, Biemond I, Lamers CB, Masclee AA. The osmotic laxative magnesium sulphate activates the ileal brake. Aliment Pharmacol Ther. 2000;14:587–95.

    CAS  Article  Google Scholar 

  24. 24.

    Steiner SA, Torres MR, Penna FJ, Gazzinelli BF, Corradi CG, Costa AS, et al. Chronic functional constipation in children: adherence and factors associated with drug treatment. J Pediatr Gastroenterol Nutr. 2014;58:598–602.

    CAS  Article  Google Scholar 

  25. 25.

    Koppen IJN, van Wassenaer EA, Barendsen RW, Brand PL, Benninga MA. Adherence to polyethylene glycol treatment in children with functional constipation is associated with parental illness perceptions, satisfaction with treatment, and perceived treatment convenience. J Pediatr. 2018;199:e1.

    Article  Google Scholar 

  26. 26.

    Imanieh MH, Golpayegan MR, Sedighi M, Ahmadi K, Aghaie A, Dehghani SM, et al. Comparison of three therapeutic interventions for chronic constipation in paediatric patients with cerebral palsy: a randomised clinical trial. Prz Gastroenterol. 2019;14:292–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Faleiros-Castro FS, de Paula ED. Constipation in patients with quadriplegic cerebral palsy: intestinal reeducation using massage and a laxative diet. Rev Esc Enferm USP. 2013;47:836–42.

    Article  Google Scholar 

  28. 28.

    Sawyer MG, Bittman M, Lag AM, Crettenden AD, Borojevic N, Raghavendra P, et al. Time demands of caring for children with cerebral palsy: what are the implications for maternal mental health? Dev Med Child Neurol. 2011;53:338–43.

    Article  Google Scholar 

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Acknowledgements

The authors are grateful to the clinical pharmacology team who performed the blinding and prepared the oral solution.

Funding

The authors received no financial support.

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Authors

Contributions

All the authors have finally reviewed the manuscript and agreed to its being submitted for publication. All individuals listed as authors meet the appropriate authorship criteria; nobody who qualifies for authorship has been omitted from the list. SMAH: research idea, patient follow-up, data collection, and writing the manuscript; SMD: clinical follow-up, data collection and writing; HB: data collection, and statistical analysis.

Corresponding author

Correspondence to Sahar M. A. Hassanein.

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Ethical approval

The study was approved by the Ethics Committee of Faculty of Medicine, Ain Shams University (IRB: FMASU MS 5/2015), Furthermore, it was registered in Clinical Trial of the National Institutes of Health with ClinicalTrials.gov identifier number: NCT02510222.

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The authors declare no financial or nonfinancial benefits have been received or will be received from any party related directly or indirectly to the subject of this article.

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Hassanein, S.M.A., Deifallah, S.M. & Bastawy, H.A. Efficacy of oral magnesium therapy in the treatment of chronic constipation in spastic cerebral palsy children: a randomized controlled trial. World J Pediatr 17, 92–98 (2021). https://doi.org/10.1007/s12519-020-00401-0

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Keywords

  • Bristol stool consistency scale
  • Constipation scale
  • Gross Motor Functional Classification system
  • Magnesium sulfate
  • Painful bowel evacuation
  • Spasticity