Spreading depolarization is a dynamic, actionable biomarker for real-time precision management in brain injury, with emerging non-invasive detection methods and potential targeted treatments like ketamine.
Patients in neurocritical care are often vulnerable to secondary brain injury, wherein spreading depolarization (SD) is identified as a pivotal electrophysiological catalyst. This study consolidates current advancements in SD research, focusing on its clinical translation into neurointensive care. A primary emphasis is the revised and accurate terminology, differentiating the depolarization event (SD) from the concomitant electrophysiological suppression termed cortical spreading depression (CSD), a distinction crucial for interpreting both fundamental and clinical data. Notable advancements in non-invasive detection, especially using full-band scalp electroencephalography (EEG) enhanced by machine learning, currently attain sensitivities of over 85%, with the potential to broaden SD monitoring outside specialized facilities. The integration of SD data with multimodal parameters—such as cerebral microdialysis (which reveals distinctive glutamate surges and metabolic crises) and tissue oxygenation—provides a more comprehension understanding of the underlying pathophysiology. The review highlights dose-dependent treatment strategies, indicating that preliminary clinical studies suggest ketamine’s effectiveness in suppressing SD may rely on maintenance dosages beyond approximately 1.15 mg/kg/h. These converging research fronts establish SD not merely as an epiphenomenon but as a dynamic, actionable biomarker for real-time precision management in brain injury.
Zhang et al. (Wed,) studied this question.