B. v. Ehrlich , D Kempten  Internal and general medicine ambulance

Dizziness is a frequent symptom in internal and general medicine office having important influence on the quality of life of patients concerned. Generally the possibility of magnesium-depletion is not taken into account in cases of dizziness or vertigo. Ower everyday experience let us to assume a relevant black box phenomenon. Regarding the fact that there is widely no established and pathophysologically based therapy fort he majority of dizziness patients the assumed  association with magnesium depletion and its detection could have high impact.

Literature search fort he association of dizziness and magnesium reveals only few casuistic papers 1) some magnesium reviews mentioning dizziness (2-6)   one observational study with  ENT patients (n=49) 7) , one Cochrane review concerning vestibular migraine – negative for triptanes , magnesium not included because of lacking data .

Methods: We analyzed  electronically based data of 20 years (2003-2023) systematically seeking Magnesium-depletion and „Schwindel“ (which includes dizziness and vertigo with e wide subjective range of patients ) All patients with treatment diagnosis Schwindel/dizziness (cohorte S) , all patients with treatment diagnosis magnesium depletion (cohorte M) ; calculation of associated magnesium depletion in cohorte S as well as prevalence of dizziness in cohort M.  All remaining cases with dizziness (cohort E n=143) – without treatment diagnosis magnesium depletion where individually screened step by step concerning Magnesium laboratory data and assumed etiology of dizziness (Table 1) In a subcohort 2015-2023 available microvascular data (AIX augmentation index ) registred with pulse wave analysis (PWV device IES Aachen/Ger) where  analyzed to get associative data for  the pathophysiological plausibility oft the magnesium-depletion association with dizziness symptoms. Definitions: Magnesium depletion Magnesium serum < 0,85mmol/l  - facultative additional criterium Mg/Ca (mmol/l/mmol/l) <0,36

Results Among  995 patients with magnesium depletion diagnosis detected 148 (15,66%) had also treatment diagnosis dizziness (n=96 64,8 % female) Of 250 patients (S cohort) with dizziness diagnose 199 had magnesium-depletion (79,6% - Mgs <0,85mmol/l) – additional can be counted 1 pt high magnesium supplemented (2000mg) external prediagnosed depletion – only 1 normal measurement in our office – 2pts with only abnormal Mg/Ca Quotient <0,36 – synoptically 80% magnesium depletion among all dizziness patients. 

The prevalence and ranking oft he assumed etiologies according to Tab 1: in der subcohort E : Rank  1: 20% „psychogen“  2. 10,4% Cardial and Cardio-macrovaskular 3. 7,6% a)others  , 7,6% b) polyetiological 5. 4,4% a) otogen  4,4% b) neurodegenerative  7. 4 % meteotrop 8. 3.2% Polyneuropathy 3,2 % medikation 10. 2,4% external induced abnormal habits 11. 0.8% toxic  12. A)0,4% vestibular migraine ,b) 0,4% neoplastic c) 0,4% epilepsy .  

Conclusions: With 80% magnesium depletion among all dizziness patients compared with prevalences of all other detectable etiologies a role of Magnesium depletion in dizziness can be assumed as probable. Especcially subgroup 1 (psy) 2, 3 a und b , 5b,7 meteotropic and 12 vestibular migraine are frequently associated with microvascular pathology (age adjusted high AIX) and this parameter reacts positive to continuous magnesium supplementation . Inclusion of AIX offers the advantage of a measurable parameter in diseases with the very subjective influenced symptom dizziness and possibility to control the influence of magnesium therapy with an objective parameter.

It has to be emphasized that in contrary with general used  procedures with dizziness patients in general medicine only a small part is otogen and also only a small part is caused by neurological severe diseases – which nevertheless must always been taken into account.  The fact that also these  (primarilyi  otogen/vestibular und primarily neurolgical) patients frequently have   magnesium depletion  let us assume that also these patients life quality can bee improved by supportive magnesium supplementation.  In one case of PostVac after external Corona Vaccination dizziness and AIX improvement by magnesium therapy could be documented. Further a patient with established vestibular migraine has documented long years lasting magnesium-depletion , AIX increase during attack and AIX as well as clinical improvement with magnesium .  The great majority of often psychogenic , cardio macrovascular and neurodegenerative , polyneuropathic and as far as PWA was done documented microvascular risik patients (e-.g. vestibular Migraine) consequent optimizing of Mgs to the aim range  (> 0,85) is a pathophysiological reasonable therapy acess. In 2022 Kolisek et al prooved by MRI technique that oral magnesium supplementation improves central nervous magnesium concentration.(9) We hypothezize that optimal serum magnesium leads to an improved resilence of patients exposed to verious dizziness inducing circumstances.

This ist o our knowledge the first investigation on the topic magnesium depletion and dizziness with a greater number of patients.

Limitations: The whole number of magnesium depletion patients is higher that electronically detected. Direct time relation of magnesium depletion and dizziness consutation is not investigated here. AIX has been established as parameter since 2015 .The number of not categorizable patients due to lack of magnesium measurement is low ( most patients with only 1 contact acting for another office or non compliance ). All patients whose magnesium depletion was detected where prescribed magnesium supplementation . The problem of compliance interfering factors has been presented by the author in Liptovsky Nikolas Magnesium meeting.

1 Blanchard 2017    2 Vormann 2016   3 Gröber 2015   4 Chakraborti 2002   5 Eby 1010

6 Wolf 2016   7 Claussen 1988   8 Webster  2023   9 Kolisek 2022

Tab 1 Etiologies of dizziness