Association of seizures with cortical spreading depression and peri-infarct depolarisations in the acutely injured human brain

Abstract

Objective-To test the co-occurrence and interrelation of ictal activity and cortical spreading depressions (CSDs) -including the related periinfarct depolarisations in acute brain injury caused by trauma, and spontaneous subarachnoid and/or intracerebral haemorrhage.Methods-63 patients underwent craniotomy and electrocorticographic (ECoG) recordings were taken near foci of damaged cortical tissue for up to 10 days.Results-32 of 63 patients exhibited CSDs (5 to 75 episodes), and 11 had ECoGraphic seizure activity (1-81 episodes). Occurrence of seizures was significantly associated with CSD, as 10 of 11 patients with seizures also had CSD (p=0.007, 2-tailed Fishers exact test).Clinically overt seizures were only observed in one patient. Each patient with CSD and seizures displayed one of four different patterns of interaction between CSD and seizures. In four patients CSD was immediately preceded by prolonged seizure activity. In three patients the two phenomena were separated in time: multiple CSDs were replaced by ictal activity. In one patient seizures appeared to trigger repeated CSDs at the adjacent electrode. In two patients ongoing repeated seizures were interrupted each time CSD occurred.Conclusions-Seizure activity occurs in association with CSD in the injured human brain. No conflicts of interestPublisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Significance-ECoG recordings in brain injury patients provide insight into pathophysiological mechanisms that is not accessible by scalp EEG recordings. NIH Public Access

Spreading Depolarization, A Pathophysiological Mechanism of Stroke and Migraine Aura

“…These findings suggested that spreading depressions of activity occur in patients with brain injury. Co-occurrence of spreading depolarizations and epileptic seizure activity in brain-injured patients was only described several years later in a study where spreading depolarizations were much more frequent than epileptic seizure activity [110].…”

“…Implantation of the recording strip in patients with brain injury was justified since clinical assessment of patients with severe brain injury is often limited as patients are frequently stuporous or comatose. Continuous monitoring of the ECoG offered the advantage for the patient that non-convulsive seizures and status epilepticus could be diagnosed that occur in brain injury at relatively high rates and are often unrecognized in the clinical routine [110][111][112]. A number of papers have suggested that acute future science group seizures and status epilepticus are associated with worse outcome [111,112].…”

“…Because of adverse effects of anticonvulsants, pharmacological seizure prophylaxis is not recommended for all patients, but detection of epileptic seizures would entail anticonvulsive treatment, since excessive metabolic demand associated with seizure activity may further compromise at-risk brain tissue. Thus, a subdural electrode strip allows for treatment stratification so that patients with seizures are treated whereas patients without are not, and unnecessary side effects of anticonvulsants are avoided [110].…”

Neurointensive Care Monitoring for Severe Traumatic Brain Injury

“…This finally leads to microarterial spasm and spreading cerebral ischaemia which act in a vicious circle (Pluta et al, 2009). In addition, cortical spreading depolarisation arising from peri-infarcted brain tissues (peri-infarcted depolarisation) underlying an ischaemic brain can also induce subclinical or non-convulsive seizures which can worsen the brain ischaemia (Fabricius et al, 2008).…”

Real-time detection of lesion development in acute brain injury

“…Now, after more than a decade of clinical studies, it is clear that spreading depolarizations are a common, recurrent pathologic mechanism in patients with stroke and brain trauma, occurring with at least four-fold greater incidence than provoked seizures. [8][9][10] With the promise of this revitalized discipline, the editors of JCBFM have commissioned the first-ever full journal issue devoted to spreading depolarizations as part of their Clinical Issues series.…”