Clinical Stimulation and Spreading Depolarization

项目总结/摘要 临床刺激和生理波动是患者早期管理的正常部分， 严重中风然而，可能的是，间歇性刺激（诱导大脑激活）或生理性刺激（诱导大脑激活）可能会导致脑缺血。 损伤（如低血压）实际上可能通过触发破坏性扩散去极化（SD）而造成伤害 脆弱的大脑中的事件。这是基于1）最近在中风小鼠模型中进行的临床前研究，2）我们的 自己的初步数据表明，这些事件与随后的SD有关，和3）结果的一个 一项重要的关键性试验显示，接受早期动员的中风患者预后较差。是 因此，严格评估常规临床干预对人类SD的影响至关重要 科目目前的研究是我们长期目标的一部分，重点是了解机制， 结果，和治疗方法相关的SD在急性神经损伤。通过这个应用程序，我们 试图确定重症监护室的正常干预是否与风险增加相关 大面积脑卒中患者感觉运动皮层中SD的水平。我们将使用硬膜下 皮质电描记电极与组织氧探头配对，位于邻近大脑皮层的感觉运动区。 大面积脑卒中患者需要行减压性半颅骨切除术时梗死边缘。我们将 然后进行长期视频EEG记录，以评估刺激事件，并收集连续的 生理测量，所有时间均锁定SD记录。SD也将按照标准标准进行评分。 我们将评估更多的刺激事件或更多的短暂生理损伤是否与 SD使用多种统计方法。这些分析将提供基本的见解， 事件可能触发SD，预计会导致卒中结局恶化。这样的调查结果 对于患者，特别是严重卒中患者，早期积极动员具有重要意义， 已被证明会导致更差的结果和更大的中风。如果更坏结果的机制 这些研究证实与SD触发有关，这将为将来的研究提供基础。 努力减轻这些影响或以SD为目标以改善结果。

PROJECT SUMMARY/ ABSTRACT Clinical stimulation and physiologic fluctuations are a normal part of the early management of patients with severe strokes. It is possible, however, that episodic stimulation (inducing brain activation) or physiologic insults (such as hypotension) could in fact cause harm by triggering damaging spreading depolarization (SD) events in vulnerable brain. This is based on 1) a recent pre-clinical study in a mouse model of stroke, 2) our own preliminary data suggesting that such events are associated with subsequent SD, and 3) results of a major pivotal trial that showed worse outcomes in stroke patients who received early mobilization. It is therefore critically important to rigorously assess the effects of routine clinical interventions on SD in human subjects. The current study is part of our long-term goals, focused on understanding the mechanisms, consequences, and therapeutic approaches related to SD in acute neurological injury. With this application, we seek to determine whether normal interventions in the intensive care unit are associated with an increased risk of SD in the sensorimotor cortex in patients with large hemispheric strokes. We will assess this using subdural electrocorticography electrodes paired with tissue oxygen probes in the sensorimotor region adjacent to the infarct border in patients with large hemispheric stroke who require decompressive hemicraniectomy. We will then perform long term video EEG recordings to assess for stimulation events and collect continuous physiological measurements, all time locked with SD recordings. SD will also be scored with standard criteria. We will these assess whether more stimulation events or more transient physiologic insults are associated with SD using several statistical approaches. These analyses will provide fundamental insights into whether such events could trigger SD, which is expected to result in worsening stroke outcomes. Such findings would have important implications for patients, particularly with severe stroke, where early aggressive mobilization has been demonstrated to result in worse outcomes and larger strokes. If the mechanism of worse outcomes in these studies is confirmed to be related to SD triggering, then this would provide the foundation for future efforts to mitigate these effects or target SD to improve outcomes.