Brown Benjamin R, Hund Samuel J, Easley Kirk A, Singer Eric L, Shuttleworth C William, Carlson Andrew P, Jones Stephen C
CerebroScope, the dba entity of SciencePlusPlease LLC, Pittsburgh, PA, United States.
Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
Imaging Neurosci (Camb). 2025 Jul 9;3. doi: 10.1162/IMAG.a.76. eCollection 2025.
Cortical spreading depolarization (SD) is increasingly recognized as a major contributor to secondary brain injury. Noninvasive SD monitoring would enable the institution of SD-based therapeutics. Our primary objective is to establish proof-of-concept validation that scalp direct-current (DC)-potentials can provide noninvasive SD detection by comparing scalp DC-shifts from a high-density electrode array to SDs detected by gold-standard electrocorticography (ECoG). Our secondary objective is to assess usability and artifact tolerance. An 83 x 58 mm thermoplastic elastomer array with 29 6-mm diameter Ag/AgCl 1-cm spaced electrodes, the CerebroPatch™ Proof-of-Concept Prototype, was adhesively placed on the forehead with an intervening electrode gel interface to record DC-electroencephalography (DC-EEG) in normal volunteers and severe acute brain injury patients in the neuro-intensive care unit some with and some without invasive ECoG electrodes. The scalp and ECoG voltages were collected by a Moberg® Advanced ICU Amplifier. Artifacts were visually identified and usability issues were recorded. SD was scored on ECoG based on DC-shifts with associated high-frequency suppression and propagation. A six-parameter Gaussian plus quadratic baseline model was used to estimate ECoG and scalp electrode time-courses and scalp-voltage heat-map movies. The similarity of the noninvasive scalp and invasive ECoG DC-shift time-courses was compared via the Gaussian fit parameters and confirmed if the Coefficient-of-Determination was >0.80. Usability and artifact issues obscured most scalp Prototype device data of the 140 ECoG-coded SDs during 11 days in one sub-arachnoid hemorrhage patient. Twenty-six of these DC-shifts were in readable, artifact-free portions of scalp recordings and 24 of these had a >0.80 Coefficient-of-Determination (0.98 [0.02], median [IQR]) between invasive ECoG and noninvasive Prototype device DC-shifts. Reconstructed heat-map movies of the scalp DC-potentials showed a 5-cm extent, -460 µV peak region that persisted for ~70 seconds. These data suggest that these scalp DC-shifts (peak -457 ± 69 µV [mean ± StD], full-width-half-maximum 70.9 ± 5.92 seconds, area 18.7 ± 2.76 cm) depicted in the heat-map movies represent noninvasively detected SDs. These results using 26 SDs as the observational units suggest that noninvasive SD detection is possible using scalp DC-potential signals with a high spatial resolution EEG array. Although the high artifact burden data and low usability records were limiting, negative results, they serve as an important entrepreneurial recipe that provides suggestions for a future, re-designed device that would reduce artifacts and improve usability for DC-EEG SD detection needed to enable multi-modal monitoring for secondary brain injury.
皮质扩散性去极化(SD)越来越被认为是继发性脑损伤的主要原因。非侵入性SD监测将有助于开展基于SD的治疗。我们的主要目标是通过将高密度电极阵列记录的头皮直流(DC)电位变化与金标准皮层脑电图(ECoG)检测到的SD进行比较,来建立头皮DC电位可提供非侵入性SD检测的概念验证。我们的次要目标是评估可用性和伪迹耐受性。将一个83×58毫米的热塑性弹性体阵列(带有29个直径6毫米、间距1厘米的Ag/AgCl电极,即CerebroPatch™概念验证原型)通过电极凝胶界面粘贴在前额,用于记录正常志愿者和神经重症监护病房中重症急性脑损伤患者的直流脑电图(DC-EEG),其中一些患者有有创ECoG电极,一些没有。头皮和ECoG电压由Moberg®高级重症监护放大器采集。通过视觉识别伪迹并记录可用性问题。基于与高频抑制和传播相关的DC变化,对ECoG上的SD进行评分。使用六参数高斯加二次基线模型来估计ECoG和头皮电极的时间进程以及头皮电压热图电影。通过高斯拟合参数比较非侵入性头皮和侵入性ECoG DC变化时间进程的相似性,并在决定系数>0.80时进行确认。在一名蛛网膜下腔出血患者的11天内,140个ECoG编码的SD中,大多数头皮原型设备数据被可用性和伪迹问题所掩盖。这些DC变化中的26个位于头皮记录的可读、无伪迹部分,其中24个在侵入性ECoG和非侵入性原型设备DC变化之间的决定系数>0.80(0.98[0.02],中位数[四分位间距])。头皮DC电位重建的热图电影显示,峰值区域为5厘米范围、-460μV,持续约70秒。这些数据表明,热图电影中描绘的这些头皮DC变化(峰值-457±69μV[平均值±标准差],半高宽70.9±5.92秒)代表了非侵入性检测到的SD。以26个SD作为观察单位的这些结果表明,使用具有高空间分辨率的脑电图阵列的头皮DC电位信号进行非侵入性SD检测是可行的。尽管高伪迹负担数据和低可用性记录具有局限性,属于阴性结果,但它们是一个重要的经验教训,为未来重新设计的设备提供了建议,该设备将减少伪迹并提高用于DC-EEG SD检测的可用性,从而实现继发性脑损伤的多模态监测。
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