Magnesium in Neurologist Practice
Katarzyna Toruńska, Magdalena Maj-Żurawska
For many years, the role of magnesium in medicine has been well known. We know that Mg is not only a membrane stabilizer, but also organelles. This fact is commonly used by scientists in studying the role of magnesium in the pathophysiology of various diseases. Huge interest is the role of magnesium deficiency in neurological diseases.Mostly common effect of Mg deficiency in tissues are teams neuromuscular hyperactivity. Magnesium is known for its role in adjunctive therapy in epilepsy syndrome, involuntary movements, neurosis, panic disorders and anxiety-depressive. Toning effect on the muscles, Mg is used in treating diseases with increased spasticity, for example multiple sclerosis or traumatic spinal cord. The role of magnesium in brain aging and Alzheimer disease has been researched. In outpatient practice, neurologist meets disorders resulting from original latent Mg deficiency in the form of latent tetany. They result from primary magnesium deficiency. This paper presents a model of diagnostic and therapeutic management of tetany, with special attention paid to the role of Mg and to psychotherapy or psychiatric treatment. Two types of tetany are distinguished: manifest tetany and latent tetany (spasmophilia). The former due to hypocalcemia, is relatively rare and usually postoperative (parathyroid tetany), while the mechanism of the much more common latent tetany or spasmophilia involves hyperventilation and Mg deficiency. Latent tetany affects particularly young women. There are many signs of spasmophilia, but none is specific, so this pathology is difficult to diagnose.
Latent tetany is becoming more and more prevalent in society. In tetany latent (spasmophilia) pathology, the substrate is an increase in the excitability of the nerve-muscle following magnesium deficiencies and/or hyperventilation. Unlike tetany overt, spasmophilia detection is usually accidental on the basis of electromyographic test. While overt signs of tetany are widely known, and attacks are easy to recognize, latent tetany (spasmophilia) is usually detected by chance in apparently healthy people, complaining on very unusual symptoms from the various organs and systems.
Latent tetany signs are resulting from a reduction in the intracellular magnesium concentration, and not from the reduction in concentration in serum. At this moment this illness can be identified on the basis of ischemic test. Much more reliable test results in determination ionized Mg in erythrocytes.
The role of magnesium has been revealed in the healing practice in two situations:
it refers to a general shortage of Mg on one hand, and much rarer excess, on the other hand.
The beginning of modern research on the effects of magnesium deficiency is associated with proving its physiological relevance in animals. In the thirties of twenty centure, there were examined rats with Mg deficiency caused by a small supply of food. These allow to discover a significant part of the physiological properties of magnesium in the development, reproduction, systems nervous and muscular, and balance of humoral immunity. It was also possible to reverse these disorders by oral supplementation of Mg.
Diehard fanatics, such as Paul Delbet, have seen in magnesium panacea, whose deficiency plays an important role in cancer formation, the formation of the epidemic, and even the frequency of suicides. To skeptics Mg appeared to be an oligoelement of Undetermined Significance for biological or physiological effect, occurring in foods in an amount sufficient to cover daily demand and nearly impossible to explore.
Between these two extreme positions, modern researchers try to discover
the real significance of magnesium in human life.
Distribution magnesium in human body
In the human body weighing 70 kg, there is approximately 24 g of Mg (this value ranges from 20g to 35g, depending on the source). About 60% of this amount falls in the bones, 29% in muscle, 10% in other soft tissues, and only 1% in the intracellular fluids. In organisms elderly people (over 60 years of age) content of Mg is reduced to 60-80% of the content in tissues of children.
The highest content of magnesium includes tissue with the greatest intensity of processes metabolism, such as brain, muscle (approx. 9,5mmol / kg), heart (approx. 16.5mmol / kg), liver and the tumor tissue (approx. 8mmol / kg). Erythrocytes contain three times more magnesium,(2,4-2,9mmol / l) than plasma (0,8-1,6mmol / l).Most of the physiological effects of Mg in the extracellular fraction depend on the ionized form of the element.
Magnesium and other elements in the blood plasma are nearly at constant concentration, due to the high homeostatic properties of the blood. However, determination of Mg in this material, although common in clinical practice, has little diagnostic value. Also, and this is because of the homeostasis, it informs to a limited extent about magnesium content in other tissues. Almost the entire pool of Mg is localized inside the cell.
The absorption of magnesium in man generally takes place in the intestines, mostly in thin intestine. This is the sum of two mechanisms: one is the process of passive diffusion, the other one is the facilitated diffusion. The facilitated diffusion is a two-step process, passive diffusion from the intestinal lumen to epithelial cells proceed Mg into the blood by mechanism dependent on metabolic energy supply. The latter process is dependent on the concentration of magnesium ion.
The absorption of Mg occurs parallel to the absorption of water. It occurs better when the duration of the process is longer. It depends on the physicochemical nature of Mg (namely, the degree of ionization), on the balance between the different components of the diet, and the balance of different hormonal secretions. Magnesium absorption is faster in acidified environment, with diet rich in animal proteins, unsaturated fats, vitamin B6, sodium, lactose, vitamin D, with secretion of insulin and parathyroid hormone.
Absorption of magnesium is inhibited by: alkalinity of the environment, some proteins, fats, saturated fatty acids forming an insoluble Mg connection, fibers food, phytic acid contained in cereals, oxalic acid found in many plants (rhubarb, spinach, sorrel), excess calcium (hence concomitant dairy products), alcohol, and insoluble combination with Mg formed by fluorides and phosphates. Therefore palatable drinks containing large amounts of buffered phosphoric acid (all-type drinks Coca-Cola), loved especially by children, decrease absorption of Mg and Ca.
The factors limiting absorption of magnesium from foods include antibiotics of
Magnesium ion is generally poorly digestible. On average, only 30% of the supply is
absorbable, (of which 10% through passive diffusion). Magnesium absorption in humans ranges from 75.8% for a diet containing very little Mg (23mg daily) to 23% for a large dose (564mg per day). Intestinal absorption, through its component in the form of facilitated diffusion as a function of saturation, is directly responsible for its adaptation to change supply. Also, the intestinal absorption affects indirect immune mechanisms in order to counter the deficiency of Mg is not associated with a shortage of supply.
The increase in magnesium absorption is observed in the case of shortage caused by excessive excretion of urine caused by furosemide. One of factors in such regulation is the free movement of intestinal tract. It was found, however, that Mg homeostasis in the blood is directly dependent on normal renal function, and moreover, the quality of the intestinal absorption. Both of these processes are not sufficient to explain the stability of the magnesium concentration in blood. There must be interaction mechanisms feedback regulating the distance distribution of ions. Here we have, of large importance, hormonal feedback regulating blood Mg levels – featured previously arrangement: adrenaline-insulin, parathyroid hormone-calcitonin.
Magnesium is mostly an intracellular element. More than half of Mg is in bones, about a quarter is in muscle, and about a quarter is distributed throughout the body, mainly in the nervous system and organs of high metabolic activity, such as liver, gastrointestinal tract, kidneys, glands endocrine. Magnesium reserve is probably above all in the bones. It is very difficult to reduce the concentration of Mg in soft parts in the course of deficit of this element.
Currently, we have little knowledge about the mechanisms of Mg transport in the cell and maintaining the increased gradient between the intra- and extracellular magnesium. Capture of by the cell probably depends on facilitated diffusion and the drain of the cells by the active transport and energy generation processes.
Vitamins B6 and D, insulin are able to increase the magnesium content in the cells.
In contrast adrenaline reduces the concentration of magnesium in the cells.
Exceptional stability of the Mg in blood due to the direct organ targeting influences transformation Mg in kidney and intestines, as well as adjustment of hormones.
The main route of magnesium elimination is renal one. Intestinal and sweat excretion are usually important in further quantitative terms. Magnesium, which gives disperse (in ions or compounds) contained in the plasma (68%) is filtered by the glomeruli
then reabsorbed at 96.5% at most in the ascending branch of the nephron. Further
absorption can take place in the descending branch of the loop nephron.
The content of magnesium in urine is increased by: all the factors triggering excess
blood calcium (Ca, vitamin D, lactose), proteins, sugars metabolized in the kidney (i.e.
glucose), alcohol, acidifiers.
The magnesium content in urine is reduced by phosphorus (in moderate doses), calcitonin,
parathyroid hormone, glucagon, insulin and vitamin D (in doses not increasing the content of calcium in blood).
Renal excretion is the major mechanism of regulating the content of magnesium
in blood. It increases in the case of excess magnesium and decreases with the
deficiency. Since the reabsorption of Mg affects the concentration, it is close to saturation of physiological magnesium in the blood, it is certain that: any excess in the blood causes automatically leveling excess excretion magnesium. The importance of this control is indisputable: it is sufficient regulation of reactive, preventing excess magnesium in the blood.
The role of magnesium in the biochemical processes of cells
The most important function of Mg is its effects on the production and activity of multiple enzymes. Mg activates more than 300 enzymes, for which the calcium ion is usually the inhibitor. A particularly important role is played by magnesium ion in the activation of enzymes associated with the formation of energy in the cell. The energy necessary for the operation of the drive phone must be drawn from the reserve potential chemical energy, which are binding mainly high-energy ATP. Forming reactions, then the use of high-energetic bonds are the basis of all cellular activities. These reactions require
the optimum magnesium ion concentration. Most Mg in need of organ cells that are most intensively working: the brain, heart, muscles. Magnesium deficiency will call
maximum disturbance in the work of these very important organs.
Mg has an effect on the functional status of the cell membranes. One of the most important properties of Mg is its role as a stabilizer membranes phones. Magnesium binds complexes with phospholipids, which reduces membrane fluidity and permeability. In this way, Mg deficiency increased permeability of the plasma membrane. The stabilizing role of magnesium is not limited to the cell membrane. Mg2+ is essential for the integrity of the anatomical and functional various cell organelles.
Magnesium maintains the mitochondrial membranes strongly coupled, i.e. in which the phosphorylation and oxidation proceed with high yield. Deficiency of Mg causes
swelling mitochondria and anarchy in occurring reactions. Cellular respiration is accelerated, whereas the phosphorylation reaction slows down. Production of ATP (phosphorylation reaction) releases because magnesium deficiency impairs transport of protons and electrons formed in the respiratory chain that is required for the phosphorylation reaction. The accumulation of protons in place of ATP formation leads to the formation of harmful active chemical groups. The result may be a complete inhibition of energy transport. Magnesium is also essential to be used in cells for forming high-energy bonds. Forming reactions, then the use of high-energy bonds are the basis of the presence of magnesium ion. This alone is enough to show the utmost importance of biological significance of magnesium.
Ribosomes also require Mg ions for maintaining their physical stability. Almost sole function of ribosomes is the production of proteins. Creating peptide chain is
possible only in the presence of Mg2+.
More than half of the magnesium contained in the cell nucleus is closely linked with nucleic acids. DNA molecules in the presence of Mg2+ take a more packed random character. Magnesium ions are bonded to form bridges between sections of DNA. It is also required in the process of DNA repair. It stabilizes the RNA molecules. It conditions also the parallel emergence of t-RNA. Mg is an essential ingredient for essential biochemical functions and as cell protecting factor.
Effect of magnesium on the nervous system
Magnesium is an sedative ion. It reduces the excitability of nerve cells. Transfixing autonomic ganglia and increasing their activity Mg inhibits and weakens their stimulant effect. Magnesium ions compete with calcium ions in nerve endings, thereby preventing excessive stimulation.
It is known that magnesium is involved in many neurological disorders, wherein the deficiency leads to the increase of disease symptoms.
The most common neurological diseases associated with a deficit of magnesium include latent tetany (attention-deficit hyperactivity neuromuscular), migraine headaches, tension headaches, loss of consciousness and seizures, teams anxiety and anxiety-depressive. There are also many neurological pathologies not directly related to Mg deficit but deepening them as a result of this deficit. Such diseases include tics and involuntary movements, myoclonic disorders, dystonia, dyskinetic disorders, diseases of dementia, degenerative brain disease (Parkinson bands dementia), mild cognitive impairment, epilepsy, congenital and late bands spasticityin various neurological lesions, bands damage peripheral nerve polyneuropathy, Lyme diseases. In these disease states, magnesium has a complementary rule treatment.
Tetany- neuromuscular hiperactivity disorder
Tetany mostly affects young people – particulary women. There are two types of the disease: hipocalcemic tetany (usually in patients after thyroidectomy, in the course of post-surgical hypoparathyroidism) occurs relatively rarely, and latent – normocalcemic tetany resulting from cellular magnesium deficiency and increased respiratory drive, occurs much more frequently. Latent tetany (spasmophilia) despite the fact that is quite common, it is rarely recognized. Since there is no symptom that would be pathognomonic.
Tetany define a medical condition that is characterized by increased neuromuscular excitability in the form of paresthesia seizures, tonic and clonic muscle contractions upper and lower limbs and cramps loud in the absence or concomitant hormonal disorders. Tetany (tetania) was first described in 1874 as a state of increased excitability nerve – muscle-term by reducing the threshold of excitability of the motor nerves to the galvanic current. Subsequent descriptions of clinical symptoms of the disease are derived from Trousseau and Chwostek. In the years 1959-1961, the first reports about the role of low magnesium levels in serum and/or erythrocytes, which could underlie the increase neuromuscular excitability, and in the years 1959-1969 Durlach described spasmophilia (latent tetany) as a syndrome associated with primary magnesium deficiency, particularly cell.
For the clinician the most useful, easy and practical division of tetany will award overt and latent tetany.
Tetany symptoms can be divided into tetany seizures and interictal symptoms. Latent tetany (spasmophilia) usually detected by chance in apparently healthy people, or administering complaints very unusual symptoms from the various organs and systems.
Tetany attack occurs in a characteristic manner, starting usually from tingling in the fingertips of hands and around the mouth. This is followed by an increased tension in the muscles of the face and limbs and their contracture. The earliest muscle spasms occur in the muscles around the ball of his thumb with a strong adduction, giving the hand shape of a “hand obstetrician”.
Attack of tetany is often accompanied by anxiety, extreme anxiety, mental stimulation, hyperventilation. Sometimes there is even loss of consciousness accompanied by convulsions. Although these are rare situations, but hazardous to the patient and always require differentiation of epilepsy.
Another symptom that could endanger the patient’s life during an attack of tetany is a muscle cramp loud. In the periods between episodes of tetany patients usually complain of restlessness, irritability, a feeling of constant fatigue, impaired memory, difficulty in concentration, insomnia, general weakness. These problems especially in combination with the feeling of continuous tingling of the face and limbs are generally regarded as erroneously Anxiety.
In contrast to the overt tetany, tetany revealing latent runs secretly in the manner diagnose spasmophilia.
Symptoms that may suggest the existence of tetany latent are divided into: central (increased nervous tension, paroxysmal syncope, insomnia, depressed mood, fatigue), peripheral (muscle spasms, numbness and tingling in the extremities, paresthesia), vegetative (pain in the precordium, palpitations, girdling pains in the chest and abdomen, bloating, colic, vasomotor disturbances in the extremities), neurological (Chwostek symptom, a symptom of Trousseau, excessive tendon reflexes), electrophysiological (picture spontaneous discharges poly-potentials).
Latent tetany is a phenomenon encountered often, but just as often not recognized. This is mainly due to the lack of reliable sources, rather scanty descriptions of this pathology in the textbooks of neurology and internal medicine, as well as the absence of a clear taxonomy of terms relating to the definition, etiology and pathogenesis phenomenon. Spasmophilia mostly affects young women who are suffering from very many non-specific symptoms and seek medical advice from a number of specialties without getting professional help only by the lack of accurate diagnosis.
Neurological examination commonly known symptoms of attention deficit hyperactivity providing neuromuscular are Chwostek symptom, a symptom of Trousseau, as well as excessive tendon reflexes.
The most sensitive test showing the presence of neuromuscular hyperactivity, and thus tetany is an electromyographic investigation – an attempt tetany (attempt ischemic). The characteristic image in the form of spontaneous recurrent at least 1 minute after activation by ischemia and/or hyperventilation discharge, poly-potential indicates the presence of tetany but not its nature. We carry out the Ischemic test introducing needle electrode in the first muscle interosseus, assuming a tourniquet for 10 minutes on the shoulder (challenge ischemia) and joining in the last two minutes of hyperventilation. After 10 minutes, we take off the tourniquet and the next 5 minutes we observe a kind of lightning on the oscilloscope screen.
Each patient, who based on electromyographic studies, found the presence of symptoms of hyperactivity neuromuscular should have made detailed morphological and biochemical studies, allowing identification of the type of pathology. In patients with latent tetany typical laboratory abnormalities may concern only the magnesium level in serum and/or erythrocytes (lowered), and blood gas (respiratory alkalosis). All other biochemical variations, particularly on the calcium-phosphate testify to the presence of overt tetany. Diagnosis of tetany is always worth complemented by a number of additional tests: electrocardiogram, electroencephalogram, echocardiogram.
Treatment of latent tetany mostly consist of magnesium supplementation and proper psychological therapy with daily requirement for magnesium for adults of 5 mg / kg body weight. It is advantageous to use preparations associating magnesium with vitamin B6, acting as a cofactor. Including therapy for a patient with spasmofilia, it should be not forget to maintain the normal levels of vitamin D3, which is the guarantor of Mg going to the tissues. Choosing magnesium preparations, one should pay attention to the type of magnesium salt and the ability of its absorption by the body. Top absorbed are: citrate, lactate and chelates. Type of formulation and the dose should be adjusted individually to the requirements of the patient. However, one should know that magnesium preparations given to the patient in the correct doses can cause a laxative effect, which is usually disappear after a few days of use. If the effect is prolonged, there is a need to change the formulation of Mg to another one. Over time, knowledge about treatment of latent tetany is expanding. Used until recently very keen beznzodiazepin class of drugs appear to be effective only as an emergency intervention procedure in a fit of panic. More and more often we reach for SSRIs very safe and selective such as escitalopram and sertraline. Treatment of latent tetany is so complex treatment. It should always be carried out by a doctor who has experience in this field. Remember that although magnesium preparations are so popular and necessary, in some states they may be dangerous for the patient (mistenia gravis, atrioventricular block, extreme renal failure).
Injections of preparations of Mg are very rarely used in spazmofilia and they are applied only to advanced hypomagnesemia. Infusions of magnesium sulfate is always used in the dilution and always under the supervision of a physician.
Some authors claim that in patients with excessive hyperventilation a practice of proper breathing is required beyond drug therapy.
Migraine headaches and tension headaches
The pathogenesis of migraine is still unclear. There are several theories about the mechanism of formation migraine, but none of them is generally accepted.
Probably migraine is associated with innate predisposition to increased vasomotor reactivity, seizure-induced changes in central nervous system. The main role of activating the system trigemino-vascular full cortical neuronal depression.
There are various concepts that attempt to explain pathomechanism of this phenomenon. Experiments in rats show that in the formation of depressed cortical NMDA receptors take part, while receptors are stimulated by low concentrations of magnesium. And according to Olesen, cortical depression is associated with increased levels of potassium. During a migraine attack there is an excessive serotonin release from platelets and subsequent contraction cerebrovascular disease and the symptoms of aura. Lowering serotonin levels while resulting in diastole arteries with subsequent vibrant headache. During migraine attack, calcitonin gene-dependent, substance P and neurokinin A are released from the nitric oxide peptides. These materials initiate a cascade of biochemical phenomena involving kinin and eicosanoids leading to edema arachnoid around blood vessels (a process called inflammation neurogenic) and a further generate a pulse of pain. Knowledge about the possible emergence patomechanism migraine headaches enables us to the right choice of effective treatment of migraine, and thus obtain an improved therapeutic effect.
Analysis of the theory of the formation of migraines and the impact hypomagnesemia on the human body shows that deficiency of magnesium may play an important role in the pathogenesis headaches, particularly – migraine. Low levels of magnesium can interfere with the processes governing muscle tension cerebral arteries. The role of magnesium is to regulate the level of nitric oxide in cells. Produced by endothelial nitric oxide is excreted smooth muscle, resulting in the formation of cGMP which in turn, is involved in the relaxation of vascular muscle membrane vessels. Hypomagnesemia inhibits release nitric oxide from endothelial cells, which in turn is responsible for impaired endothelium-dependent vasodilation and results in excessive contractile response. Lowering the levels of Mg also reduces relaxing prostacyclin effect on vascular smooth muscle. The important role of magnesium is also to reduce the formation inflammatory eicosanoids (including prostacyclin and thromboxane).
Magnesium also works as anticoagulant – handicapping production of a strong agonist of platelet function, which is thromboxane A2. Hypomagnesemia causes so platelet aggregation which secondarily released serotonin. An important task of magnesium is its effect on NMDA receptors. Under quiescent potential membrane NMDA receptors are blocked by ions magnesium (so-called. Mg block) binding of glutamate and opening the receptor is impossible. The condition NMDA receptor activation is depolarisation cell, the magnesium ion is released which allows a conformational change of the NMDA receptor and its opening the flow of calcium ions. Therefore, another
due to the low level of magnesium ions is to increase NMDA receptor sensitivity to glutamate which causes rapid spread of depressed cortical Mg is also involved in mitochondrial phosphorylation oxidative. Low magnesium level can cause deficits of bioenergy. It seems that there could also be an additional factor the formation of the migraine aura. The use of well-absorbable material containing magnesium 400 mg of magnesium ions per day for an adult reduces migraine attacks within a month.
Loss of consciousness and seizure disorders
Loss of consciousness is a disease with a very rich etiology. The reasons that can cause loss of consciousness and other seizure disorders are the cause of a cardiac (cardiac arrhythmia) causes neurogenic (epilepsy), electrolyte disturbances (hypomagnesemia, hiopo and hyperkalemia, hipocalcemia), acid-base balance disorder (acidosis and alkalosis metabolic and respiratory), febrile illness.
Advanced hypomagnesemia is a cause of hyperexcitability of neurons of the central nervous system that vent to the uncontrolled and abnormal represent the epileptogenic focus, which leads to loss of consciousness and even seizure. It has been shown that the addition of formulation well absorbable magnesium vitamin B6 antiepileptic stabilizes the cell membrane of a neuron reducing the number of seizures. Hypomagnesemia may also lead to cardiac arrhythmias and respiratory alkalosis which in turn can also lead to loss of consciousness and seizures fall. It should be emphasized that the use of anticonvulsant drugs also affects the balance of Mg stocks adjuvant therapy is fully justified.
Stress and anxiety-depressive teams
A deficiency of magnesium in the body causes the symptoms of drug panic and depressed mood. This is obviously associated with serotonin deficiency in the presynaptic slot that correct amount is dependent on the correct concentration of magnesium inside neuron. It happens that patients over many years are treated with an antidepressant without supplements of Mg deficiency without any therapeutic effect. It is known that antidepressants may influence the loss of magnesium in urine, so supplementation with this element during such treatment is necessary. Stress, anxiety and panic attacks will activate the release of the hormones of the adrenal cortex and medulla such as adrenaline, noradrenaline and cortisol, which in turn accelerates the loss of magnesium in urine. This is called a vicious circle. On the one hand magnesium deficiency causes symptoms of the drug, panic and depression, and on the other hand, these symptoms initiate a cascade of reactions leading to deepening this deficiency. Clearly, the antidepressant treatment is not able to break the vicious circle. Proper Mg supplementation is well absorbable dial out of this difficult situation.
There are also many neurological pathologies not directly related to magnesium deficit but deepening as a result of this deficit. Such diseases include tics and involuntary movements, myoclonic disorders, dystonia, dyskinetic disorders, RLS syndrom, diseases of dementia, degenerative brain disease (Parkinson bands dementia), mild cognitive impairment, epilepsy, congenital and late one, spasticy in various neurological lesions, bands damage peripheral nerve, polyneuropathy, Lyme diseases (neuroborreliosis). In these disease states, magnesium has a complementary rule treatment.
From the above diseases, neuroborreliosis (Lyme diseases) deserves a special attention. Pathogen responsible for causing this disease is an intracellular bacterium that to its survival and distribution of genetic material just needs magnesium. Patients who have developed so called Lyme disease suffer from huge deficits magnesium in the form of a large muscle tension especially neck and calves, muscle cramps, muscle twitching, numbness, tingling, muscle pain. The characteristic of this disease, also dependent on cellular magnesium levels, is a very low tolerance of exercise and alcohol. Large number of different symptoms of the disease is often incorrectly treated as a neurosis or hypochondria and treated psychiatrically. In the treatment of Lyme disease (neuroborreliosis) supplementation with magnesium and vitamin D3 is essential. Our experience shows that adding the product well absorbable magnesium formulation at a dose of 350-400mg a day improves the well-being of the patient during treatment with antibiotics.
In September 2015, we started a research program on levels of ionized magnesium and other elements in erythrocytes in patients with latent tetany confirmed by the ischemic test. We hope for very interesting conclusion from this study. Until now, we have found some interesting results and interesting correlations, such as presented in Fig. We have found the concentration of electrolytes within normal range in blood plasma. However, ionized magnesium and ionized calcium are in lower level of the normal range. The concentration of vitamin D is in lover level of normal range. In erythrocytes, ionized magnesium and total magnesium concentrations are under normal range. Ionized calcium concentration seems to be in higher level of normal range. Total calcium concentration is in lower level of normal range. Potassium concentration is in lower level of normal range.
The results of the blood test show us the diagnosis and treatment of neurological diseases such as lyme disease, migraine, epilepsy, polyneuropathy, latent tetany, myopathy, neurosis, depression.