Detecting Cortical Spreading Depolarization with Full Band Scalp Electroencephalography: An Illusion?
Detecting Cortical Spreading Depolarization with Full Band Scalp Electroencephalography: An Illusion?
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DOI：
10.3389/fneur.2018.00017
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发表时间：
2018-01-25
影响因子：
3.4
通讯作者：
van Putten, Michel J. A. M.
中科院分区：
文献类型：
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作者：
Hofmeijer, Jeannette;van Kaam, C. R.;van Putten, Michel J. A. M.
简介：有强有力的证据表明，在急性缺血性卒中和严重创伤性脑损伤患者中，皮层扩展性去极化（CSD）具有不利影响。先前的研究暗示头皮脑电图（EEG）特征是CSD的相关性，其基于在时间对准的皮层脑电图中检测到“CSD”后对EEG时期的回顾性分析。我们研究了CSD检测的可行性，在一项前瞻性队列研究连续脑电图在18例急性缺血性脑卒中和18例急性重型traumatic brain injury.Methods：全频带脑电图与21银/银氯化物电极在48小时内开始症状发作。在梗塞区上方使用了五个额外的电极。我们在1小时的时间段内对所有原始EEG数据进行了可视化分析。检查的目的是检测CSD特征的典型组合，即，(i)一个大的缓慢的电位变化（SPC）伴随着一个同步幅度下降> 1Hz的活动，（ii）局灶性表现，和（iii）传播反映为外观上的相邻electrodes与delay.Results：在3,035个一小时的EEG epoch，次声活动（伊萨）存在于一半到四分之三的注册时间。通常，活动是间歇性的，振幅为40-220 μ V，大约一半是振荡的。没有特定的空间分布。伊萨的相关变化在多个电极中始终可见，而不是CSD中预期的局灶性变化。以“SPC”出现的伊萨主要与快活动的振幅增加有关，而与抑制无关。在所有患者中，自发脑活动的抑郁症发生。然而，这些都没有伴随着同时SPC，同时发生在所有通道，并没有焦点，更不用说传播，如预期在CSD。结论：与全频带头皮脑电图皮质缺血性中风或创伤性脑损伤患者，我们观察到各种伊萨，可能调制皮质兴奋性。然而，我们无法确定CSD的明确特征。
Introduction: There is strong evidence suggesting detrimental effects of cortical spreading depolarization (CSD) in patients with acute ischemic stroke and severe traumatic brain injury. Previous studies implicated scalp electroencephalography (EEG) features to be correlates of CSD based on retrospective analysis of EEG epochs after having detected "CSD" in time aligned electrocorticography. We studied the feasibility of CSD detection in a prospective cohort study with continuous EEG in 18 patients with acute ischemic stroke and 18 with acute severe traumatic brain injury.Methods: Full band EEG with 21 silver/silver chloride electrodes was started within 48 h since symptom onset. Five additional electrodes were used above the infarct. We visually analyzed all raw EEG data in epochs of 1 h. Inspection was directed at detection of the typical combination of CSD characteristics, i.e., (i) a large slow potential change (SPC) accompanied by a simultaneous amplitude depression of > 1Hz activity, (ii) focal presentation, and (iii) spread reflected as appearance on neighboring electrodes with a delay.Results: In 3,035 one-hour EEG epochs, infraslow activity (ISA) was present in half to three quarters of the registration time. Typically, activity was intermittent with amplitudes of 40-220 mu V, approximately half was oscillatory. There was no specific spatial distribution. Relevant changes of ISA were always visible in multiple electrodes, and not focal, as expected in CSD. ISA appearing as "SPC" was mostly associated with an amplitude increase of faster activities, and never with suppression. In all patients, depressions of spontaneous brain activity occurred. However, these were not accompanied by simultaneous SPC, occurred simultaneously on all channels, and were not focal, let alone spread, as expected in CSD.Conclusion: With full band scalp EEG in patients with cortical ischemic stroke or traumatic brain injury, we observed various ISA, probably modulating cortical excitability. However, we were unable to identify unambiguous characteristics of CSD.