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

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• 作者：Martin Fabricius ; Susanne Fuhr ; Lisette Willumsen ; Jens P. Dreier ; Robin Bhatia ; Martyn G. Boutelle ; Jed A. Hartings ; Ross Bullock ; Anthony J. Strong ; Martin Lauritzen
• 关键词：Brain injury ; Secondary damage ; Seizures ; Peri-infarct depolarisations ; Cortical spreading depression
• 刊名：Clinical Neurophysiology
• 出版年：2008
• 出版时间：September 2008
• 年：2008
• 卷：119
• 期：9
• 页码：1973-1984
• 全文大小：850 K

文摘

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 (5–75 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 2 patients ongoing repeated seizures were interrupted each time CSD occurred.

Conclusions

Seizure activity occurs in association with CSD in the injured human brain.

Significance

ECoG recordings in brain injury patients provide insight into pathophysiological mechanisms, which are not accessible by scalp EEG recordings.