Sueiras Maria, Thonon Vanessa, Santamarina Estevo, Sánchez-Guerrero Ángela, Poca Maria A, Quintana Manuel, Riveiro Marilyn, Sahuquillo Juan
Department of Clinical Neurophysiology, Vall d'Hebron University Hospital, Barcelona, Spain.
Neurotrauma and Neurosurgery Research Unit (UNINN), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
J Clin Neurophysiol. 2021 Jan 1;38(1):47-55. doi: 10.1097/WNP.0000000000000648.
Spreading depolarization (SD) phenomena are waves of neuronal depolarization, which propagate slowly at a velocity of 1 to 5 mm/minute and can occur in patients with ischemic or hemorrhagic stroke, traumatic brain injury, and migraine with aura. They form part of secondary injury, occurring after spreading ischemia. The purposes of this study were to describe the frequency and characteristics of SD phenomena and to define whether a correlation existed between SD and outcome in a group of patients with TBI and large hemispheric ischemic stroke.
This was a prospective observational study of 39 adult patients, 17 with malignant middle cerebral artery infarction and 22 with moderate or severe traumatic brain injury, who underwent decompressive craniectomy and multimodal neuromonitoring including electrocorticography. Identification, classification, and interpretation of SDs were performed using the published recommendations from the Cooperative Study on Brain Injury Depolarization group. The outcomes assessed were functional disability at 6 and 12 months after injury, according to the extended Glasgow outcome scale, Barthel index, and modified Rankin scale.
Four hundred eighty-three SDs were detected, in 58.9% of the patients. Spreading depolarizations were more common, particularly the isoelectric SD type, in patients with malignant middle cerebral artery infarction (P < 0.04). In 65.21% of patients with SDs on electrocorticography, the "peak" day of depolarization was day 0 (the first 24 hours of recording). Spreading depolarization convulsions were present in 26.08% of patients with SDs. Patients with more SDs and higher depolarization indices scored worse on extended Glasgow outcome scale (6 months) and Barthel index (6 and 12 months) (P < 0.05).
Evidence on SD phenomena is important to ensure continued progress in understanding their pathophysiology, in the search for therapeutic targets to avoid additional damage from these secondary injuries.
扩散性去极化（SD）现象是神经元去极化波，以1至5毫米/分钟的速度缓慢传播，可发生于缺血性或出血性脑卒中、创伤性脑损伤以及伴有先兆的偏头痛患者。它们是继发性损伤的一部分，在扩散性缺血后出现。本研究的目的是描述SD现象的频率和特征，并确定在一组创伤性脑损伤和大脑半球大面积缺血性脑卒中患者中，SD与预后之间是否存在相关性。
这是一项对39例成年患者的前瞻性观察性研究，其中17例为恶性大脑中动脉梗死患者，22例为中度或重度创伤性脑损伤患者，这些患者均接受了减压颅骨切除术和包括皮层脑电图在内的多模态神经监测。使用脑损伤去极化合作研究组发布的建议对SD进行识别、分类和解释。根据扩展格拉斯哥预后量表、巴氏指数和改良Rankin量表评估损伤后6个月和12个月时的功能残疾情况。
共检测到483次SD，58.9%的患者出现该现象。在恶性大脑中动脉梗死患者中，扩散性去极化更为常见，尤其是等电位SD类型（P<0.04）。在皮层脑电图显示有SD的患者中，65.21%的患者去极化“峰值”日为第0天（记录的最初24小时）。26.08%有SD的患者出现扩散性去极化惊厥。SD次数更多且去极化指数更高的患者在扩展格拉斯哥预后量表（6个月）和巴氏指数（6个月和12个月）上得分更差（P<0.05）。
关于SD现象的证据对于确保在理解其病理生理学方面持续取得进展、寻找治疗靶点以避免这些继发性损伤造成额外损害非常重要。
