Non-invasive detection of spreading depolarization using scalp electroencephalography
Non-invasive electroencephalogram (EEG)-based methods for detecting a spreading depolarization secondary to a brain injury in a patient who exhibits high-amplitude delta activity in at least one channel of a scalp EEG of an injured brain hemisphere of the patient include (a) recording a baseline scalp EEG pattern in the patient at a channel exhibiting high amplitude delta activity; (b) recording a continuous scalp EEG pattern in the patient across a time frame at the at least one channel; and (c) detecting a spreading depolarization during the time frame by observing at least one feature indicative of a spreading depolarization in the continuous scalp EEG recording pattern relative to the baseline scalp EEG pattern at the at least one channel. Scalp EEG recordings are time-compressed prior to analysis. Methods of treating brain-injured patients and triaging brain-injured patients apply the non-invasive EEG methods.
1. A non-invasive method of detecting a spreading depolarization secondary to a brain injury in a patient and reducing extent of a secondary brain injury, the method comprising:
(a) recording a baseline scalp electroencephalogram (EEG) pattern at a compressed time scale of 40-90 mm/hr of an injured brain hemisphere of the patient in at least one bipolar channel;
(b) recording a continuous scalp EEG pattern in the patient at the compressed time scale of 40-90 mm/hr across a time frame in the at least one bipolar channel to record a baseline; and
(c) detecting a spreading depolarization during the time frame by observing a depression in delta activity across a depression period from the baseline in the recorded continuous scalp EEG pattern relative to the recorded baseline scalp EEG pattern recording in the at least one bipolar channel, and
(d) initiating neuroprotective therapy effective to reduce frequency and duration of spreading depolarization when spreading depolarization is detected in (c).
2. The non-invasive method according to claim 1 , wherein the depression period is defined from onset of a depression until recovery to a steady-state amplitude.
3. The non-invasive method according to claim 1 , further comprising verifying the spreading by observing in two or more channels with a time delay between onset.
4. The non-invasive method according to claim 3 , wherein all channels are intra-hemispheric.
5. The non-invasive method according to claim 2 , wherein an observed depression comprises an isolated depression across the depression period.
6. The non-invasive method according to claim 1 , wherein an observed depression comprises continuous depression across the depression period.
7. The non-invasive method according to claim 1 , wherein at least eight EEG electrodes are located across the injured brain hemisphere.
8. The non-invasive method according to claim 1 , wherein the steps of recording are effectuated with DC-coupled EEG amplifiers.
9. The non-invasive method according to claim 1 , wherein the depression comprises a spreading shift in direct-current potential occur in a 0.0 to 0.05 Hertz frequency band.
10. The method of claim 9 , wherein the spreading shift in direct-current potential comprises an isolated shift or a continuous shift.
11. The method of claim 9 , wherein the spreading shift in direct-current potential is observed in a single EEG channel.
12. The method of claim 9 , wherein the spreading shift in direct-current potential occurs in two or more EEG channels with a time delay between onset.
13. The method of claim 1 , wherein the continuous scalp EEG pattern is a measurement of direct current potential.
14. The method of claim 1 , wherein the depression in delta activity is of up to 47% from the baseline.