Spreading depression in continuous electroencephalography of brain trauma

Hartings, Jed A.; Wilson, Jeffrey A.; Hinzman, Jason M.; Pollandt, Sebastian; Dreier, Jens P.; DiNapoli, Vince; Ficker, David M.; Shutter, Lori; Andaluz, Norberto

doi:10.1002/ana.24256

Cited by 109 publications

(76 citation statements)

References 40 publications

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“…It has been shown that the negative DC shifts of SD can be detected with scalp DC‐EEG,33, 59 although important ambiguities remain and further research is needed to develop a reliable technique. In the case of abrupt ischemia, recordings might be particularly complicated by large BBB‐generated DC potentials due to p ti O 2 and p ti CO 2 changes 49, 50.…”

Section: Resultsmentioning

confidence: 99%

Terminal spreading depolarization and electrical silence in death of human cerebral cortex

Dreier

Major

Foreman

et al. 2018

Annals of Neurology

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114

138

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ObjectiveRestoring the circulation is the primary goal in emergency treatment of cerebral ischemia. However, better understanding of how the brain responds to energy depletion could help predict the time available for resuscitation until irreversible damage and advance development of interventions that prolong this span. Experimentally, injury to central neurons begins only with anoxic depolarization. This potentially reversible, spreading wave typically starts 2 to 5 minutes after the onset of severe ischemia, marking the onset of a toxic intraneuronal change that eventually results in irreversible injury.MethodsTo investigate this in the human brain, we performed recordings with either subdural electrode strips (n = 4) or intraparenchymal electrode arrays (n = 5) in patients with devastating brain injury that resulted in activation of a Do Not Resuscitate–Comfort Care order followed by terminal extubation.ResultsWithdrawal of life‐sustaining therapies produced a decline in brain tissue partial pressure of oxygen (ptiO2) and circulatory arrest. Silencing of spontaneous electrical activity developed simultaneously across regional electrode arrays in 8 patients. This silencing, termed “nonspreading depression,” developed during the steep falling phase of ptiO2 (intraparenchymal sensor, n = 6) at 11 (interquartile range [IQR] = 7–14) mmHg. Terminal spreading depolarizations started to propagate between electrodes 3.9 (IQR = 2.6–6.3) minutes after onset of the final drop in perfusion and 13 to 266 seconds after nonspreading depression. In 1 patient, terminal spreading depolarization induced the initial electrocerebral silence in a spreading depression pattern; circulatory arrest developed thereafter.InterpretationThese results provide fundamental insight into the neurobiology of dying and have important implications for survivable cerebral ischemic insults. Ann Neurol 2018;83:295–310

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Section: Resultsmentioning

confidence: 99%

Terminal spreading depolarization and electrical silence in death of human cerebral cortex

Dreier

Major

Foreman

et al. 2018

Annals of Neurology

Self Cite

114

138

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“…On this basis, non-invasive technologies to measure rCBF and its surrogates and cEEG should be further advanced to broaden the availability of information on SDs from non-surgical patient populations (Drenckhahn et al, 2012;Hartings et al, 2014). A caveat to consider though is that non-invasive technologies alone are not yet sufficient to reliably diagnose SDs.…”

Section: Discussionmentioning

confidence: 99%

“…Only in the last two decades, subdural ECoG recordings in patients and measurements in brain slices provided unequivocal electrophysiological evidence that SDs do occur in the human brain (Avoli et al, 1991;Dohmen et al, 2008;Dreier et al, 2006Dreier et al, , 2009Fabricius et al, 2006;Hartings et al, 2011aHartings et al, , 2011bMayevsky et al, 1996;Strong et al, 2002). SD's correlates in the scalp EEG were identified with simultaneous recordings of subdural ECoG and continuous scalp EEG (cEEG) (Drenckhahn et al, 2012;Hartings et al, 2014), and animal studies revealed that the propensity to SD markedly declines in Neuron 86, May 20, 2015 ª2015 Elsevier Inc. 913 Neuron Review the course of epileptogenesis (Kö hling et al, 2003;Maslarova et al, 2011;Tomkins et al, 2007).…”

Section: The Clinical Correlates Of Sustained Depolarizationsmentioning

confidence: 99%

The Stroke-Migraine Depolarization Continuum

Dreier

Reiffurth

2015

Neuron

284

359

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The term spreading depolarization (SD) refers to waves of abrupt, sustained mass depolarization in gray matter of the CNS. SD, which spreads from neuron to neuron in affected tissue, is characterized by a rapid near-breakdown of the neuronal transmembrane ion gradients. SD can be induced by hypoxic conditions--such as from ischemia--and facilitates neuronal death in energy-compromised tissue. SD has also been implicated in migraine aura, where SD is assumed to ascend in well-nourished tissue and is typically benign. In addition to these two ends of the "SD continuum," an SD wave can propagate from an energy-depleted tissue into surrounding, well-nourished tissue, as is often the case in stroke and brain trauma. This review presents the neurobiology of SD--its triggers and propagation mechanisms--as well as clinical manifestations of SD, including overlaps and differences between migraine aura and stroke, and recent developments in neuromonitoring aimed at better diagnosis and more targeted treatments.

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“…The long-term functional significance of this surprising lability of dendritic spine morphology to cognitive function, and future susceptibility to a range of pathologies from Alzheimer's to epilepsy to migraine, is unknown. However, it seems a reasonable hypothesis that the complete recovery of spine size at their former locations following SD that is promoted by GLYX-13 is likely to be therapeutically beneficial in preventing long-term negative sequelae of migraine, and other generators of SDs such as traumatic brain injury (Hartings et al, 2009(Hartings et al, , 2014Sword et al, 2013), ischemia (Risher et al, 2010) and seizures (Takano et al, 2007).…”

Section: Discussionmentioning

confidence: 99%