Efficacy and tolerability of magnesium sulfate in children with infantile epileptic spasms syndrome: A systematic review and meta-analysis

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#humans #spasms-infantile #magnesium-sulfate #anticonvulsants #adrenocorticotropic-hormone

Efficacy and tolerability of magnesium sulfate in children with infantile epileptic spasms syndrome: A systematic review and meta-analysis

Sharawat et al., 2025 | Epilepsy Res | Meta Analysis

Citation

Sharawat Indar Kumar, Kasinathan Ananthanarayanan, ... Panda Prateek Kumar. Efficacy and tolerability of magnesium sulfate in children with infantile epileptic spasms syndrome: A systematic review and meta-analysis. Epilepsy Res. 2025-Nov;217:107628. doi:10.1016/j.eplepsyres.2025.107628

Abstract

BACKGROUND: Several trials and clinical studies have explored the efficacy and safety of magnesium sulfate (MgSO₄) in children with infantile epileptic spasms syndrome (IESS). However, no systematic review has been conducted to synthesize the available evidence. METHODS: This systematic review aimed to assess the efficacy and safety of MgSO₄ in children with IESS. The primary outcomes included the proportion of patients achieving spasm freedom, a favorable response in the number of spasms (defined as at least a 50 % reduction in daily spasms), resolution of hypsarrhythmia, improvement in developmental quotient, and the nature and frequency of adverse events. Additionally, we compared these variables between the ACTH+MgSO₄ combination therapy and ACTH monotherapy at various time points. We included all controlled and uncontrolled trials, as well as prospective and retrospective cohort studies. RESULTS: A total of four studies involving 1334 IESS patients were identified. The proportion of patients achieving a favorable response in daily spasm frequency, spasm freedom, hypsarrhythmia resolution, and EEG normalization was higher in the adrenocorticotropic hormone (ACTH)+MgSO₄ group than in the ACTH monotherapy group (RR=1.22, 95 % CI: 1.09-1.36, I²=0 %, p = 0.0004; RR=1.44, 95 % CI: 1.24-1.67, I²=29 %, p < 0.00001; RR=1.27, 95 % CI: 1.15-1.41, I²=0 %, p < 0.00001; and RR=1.46, 95 % CI: 1.06-2.02, I²=0 %, p = 0.02, respectively). The proportion of patients experiencing treatment-emergent adverse events and serious adverse events was comparable between the ACTH+MgSO₄ and ACTH monotherapy groups (RR=0.55, 95 % CI: 0.28-1.07, I²=49 %, p = 0.08; and RR=1.15, 95 % CI: 0.74-1.79, I²=0 %, p = 0.54, respectively). However, the frequency of hypertension was significantly lower in the ACTH+MgSO₄ group compared to the ACTH monotherapy group (RR=0.11, 95 % CI: 0.03-0.34, I²=0 %, p = 0.0002). CONCLUSIONS: The combination of ACTH and MgSO₄ is more effective than ACTH monotherapy in achieving seizure control in children with IESS. Additionally, it is associated with a reduced risk of certain adverse events, such as hypertension.

Key Findings

A total of four studies involving 1334 IESS patients were identified. The proportion of patients achieving a favorable response in daily spasm frequency, spasm freedom, hypsarrhythmia resolution, and EEG normalization was higher in the adrenocorticotropic hormone (ACTH)+MgSO₄ group than in the ACTH monotherapy group (RR=1.22, 95 % CI: 1.09-1.36, I²=0 %, p = 0.0004; RR=1.44, 95 % CI: 1.24-1.67, I²=29 %, p < 0.00001; RR=1.27, 95 % CI: 1.15-1.41, I²=0 %, p < 0.00001; and RR=1.46, 95 % CI: 1.06-2.02

Outcomes Measured

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Population

Field Value
Population See abstract
Sample Size See abstract
Age Range See abstract
Condition hypertension

MeSH Terms

  • Humans
  • Spasms, Infantile
  • Magnesium Sulfate
  • Anticonvulsants
  • Adrenocorticotropic Hormone
  • Infant
  • Treatment Outcome
  • Child
  • Electroencephalography

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Systematic Review, Meta-Analysis
  • Vertical: magnesium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09