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


CONCLUSIONS
ECoG recordings in brain injury patients provide insight into pathophysiological mechanisms, which are not accessible by scalp EEG recordings.
Fabricius
Martin
M
Department of Clinical Neurophysiology, Glostrup Hospital, Nordre Ringvej, 2600 Glostrup, Denmark. fabricius@dadlnet.dk
Fuhr
Susanne
S
Willumsen
Lisette
L
Dreier
Jens P
JP
Bhatia
Robin
R
Boutelle
Martyn G
MG
Hartings
Jed A
JA
Bullock
Ross
R
Strong
Anthony J
AJ
Lauritzen
Martin
M
D000328:Adult; D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001930:Brain Injuries / Q000150:complications* / Q000473:pathology*; D002544:Cerebral Infarction / Q000188:drug therapy / Q000503:physiopathology*; D013181:Cortical Spreading Depression / Q000187:drug effects / Q000502:physiology*; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012640:Seizures / Q000188:drug therapy / Q000209:etiology*; D013997:Time Factors
D000927:Anticonvulsants