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Zdunczyk A, Schumm L, Helgers SOA, Nieminen-Kelhä M, Bai X, Major S, Dreier JP, Hecht N, Woitzik J. Ketamine-induced prevention of SD-associated late infarct progression in experimental ischemia. Sci Rep 2024; 14:10186. [PMID: 38702377 PMCID: PMC11068759 DOI: 10.1038/s41598-024-59835-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/16/2024] [Indexed: 05/06/2024] Open
Abstract
Spreading depolarizations (SDs) occur frequently in patients with malignant hemispheric stroke. In animal-based experiments, SDs have been shown to cause secondary neuronal damage and infarct expansion during the initial period of infarct progression. In contrast, the influence of SDs during the delayed period is not well characterized yet. Here, we analyzed the impact of SDs in the delayed phase after cerebral ischemia and the potential protective effect of ketamine. Focal ischemia was induced by distal occlusion of the left middle cerebral artery in C57BL6/J mice. 24 h after occlusion, SDs were measured using electrocorticography and laser-speckle imaging in three different study groups: control group without SD induction, SD induction with potassium chloride, and SD induction with potassium chloride and ketamine administration. Infarct progression was evaluated by sequential MRI scans. 24 h after occlusion, we observed spontaneous SDs with a rate of 0.33 SDs/hour which increased during potassium chloride application (3.37 SDs/hour). The analysis of the neurovascular coupling revealed prolonged hypoemic and hyperemic responses in this group. Stroke volume increased even 24 h after stroke onset in the SD-group. Ketamine treatment caused a lesser pronounced hypoemic response and prevented infarct growth in the delayed phase after experimental ischemia. Induction of SDs with potassium chloride was significantly associated with stroke progression even 24 h after stroke onset. Therefore, SD might be a significant contributor to delayed stroke progression. Ketamine might be a possible drug to prevent SD-induced delayed stroke progression.
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Affiliation(s)
- A Zdunczyk
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - L Schumm
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S O A Helgers
- Department of Neurosurgery, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
- Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - M Nieminen-Kelhä
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - X Bai
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - S Major
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J P Dreier
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Bernstein Center for Computational Neuroscience Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - N Hecht
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Johannes Woitzik
- Department of Neurosurgery, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
- Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
- University Clinic for Neurosurgery, Marienstr. 11, 26121, Oldenburg, Germany.
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MacLean MA, Muradov JH, Greene R, Van Hameren G, Clarke DB, Dreier JP, Okonkwo DO, Friedman A. Memantine inhibits cortical spreading depolarization and improves neurovascular function following repetitive traumatic brain injury. SCIENCE ADVANCES 2023; 9:eadj2417. [PMID: 38091390 PMCID: PMC10848720 DOI: 10.1126/sciadv.adj2417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023]
Abstract
Cortical spreading depolarization (CSD) is a promising target for neuroprotective therapy in traumatic brain injury (TBI). We explored the effect of NMDA receptor antagonism on electrically triggered CSDs in healthy and brain-injured animals. Rats received either one moderate or four daily repetitive mild closed head impacts (rmTBI). Ninety-three animals underwent craniectomy with electrocorticographic (ECoG) and local blood flow monitoring. In brain-injured animals, ketamine or memantine inhibited CSDs in 44 to 88% and 50 to 67% of cases, respectively. Near-DC/AC-ECoG amplitude was reduced by 44 to 75% and 52 to 67%, and duration by 39 to 87% and 61 to 78%, respectively. Daily memantine significantly reduced spreading depression and oligemia following CSD. Animals (N = 31) were randomized to either memantine (10 mg/kg) or saline with daily neurobehavioral testing. Memantine-treated animals had higher neurological scores. We demonstrate that memantine improved neurovascular function following CSD in sham and brain-injured animals. Memantine also prevented neurological decline in a blinded, preclinical randomized rmTBI trial.
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Affiliation(s)
- Mark A. MacLean
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Jamil H. Muradov
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - Ryan Greene
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - Gerben Van Hameren
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - David B. Clarke
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Jens P. Dreier
- Center for Stroke Research Berlin, Charite University, Berlin, Germany
| | - David O. Okonkwo
- Division of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Alon Friedman
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
- Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
- Departments of Brain and Cognitive Sciences, Physiology and Cell Biology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Mosneag IE, Flaherty SM, Wykes RC, Allan SM. Stroke and Translational Research - Review of Experimental Models with a Focus on Awake Ischaemic Induction and Anaesthesia. Neuroscience 2023:S0306-4522(23)00535-3. [PMID: 38065289 DOI: 10.1016/j.neuroscience.2023.11.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/28/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023]
Abstract
Animal models are an indispensable tool in the study of ischaemic stroke with hundreds of drugs emerging from the preclinical pipeline. However, all of these drugs have failed to translate into successful treatments in the clinic. This has brought into focus the need to enhance preclinical studies to improve translation. The confounding effects of anaesthesia on preclinical stroke modelling has been raised as an important consideration. Various volatile and injectable anaesthetics are used in preclinical models during stroke induction and for outcome measurements such as imaging or electrophysiology. However, anaesthetics modulate several pathways essential in the pathophysiology of stroke in a dose and drug dependent manner. Most notably, anaesthesia has significant modulatory effects on cerebral blood flow, metabolism, spreading depolarizations, and neurovascular coupling. To minimise anaesthetic complications and improve translational relevance, awake stroke induction has been attempted in limited models. This review outlines anaesthetic strategies employed in preclinical ischaemic rodent models and their reported cerebral effects. Stroke related complications are also addressed with a focus on infarct volume, neurological deficits, and thrombolysis efficacy. We also summarise routinely used focal ischaemic stroke rodent models and discuss the attempts to induce some of these models in awake rodents.
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Affiliation(s)
- Ioana-Emilia Mosneag
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, United Kingdom.
| | - Samuel M Flaherty
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
| | - Robert C Wykes
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, United Kingdom; Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Stuart M Allan
- Division of Neuroscience, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Northern Care Alliance NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
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Frattale I, Papetti L, Ursitti F, Sforza G, Monte G, Voci A, Proietti Checchi M, Mazzone L, Valeriani M. Visual Disturbances Spectrum in Pediatric Migraine. J Clin Med 2023; 12:jcm12082780. [PMID: 37109116 PMCID: PMC10143789 DOI: 10.3390/jcm12082780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
Migraine is a complex neurological disorder with partially unknown pathophysiological mechanisms. The prevalence in childhood ranges from 7.7% to 17.8%, thus representing the most frequent primary headache. In half of the cases, migraine is accompanied or preceded by various neurological disturbances, among which the visual aura is the best known. In literature, other conditions, such as Alice in Wonderland Syndrome and Visual Snow syndrome, are characterized by visual manifestations and are often associated with migraine. The aim of this narrative review is to describe the spectrum of visual disturbances in pediatric migraine and their pathophysiological mechanisms.
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Affiliation(s)
- Ilaria Frattale
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Hospital of Rome, Tor Vergata University, 00165 Rome, Italy
| | - Laura Papetti
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Fabiana Ursitti
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Giorgia Sforza
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Gabriele Monte
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | - Alessandra Voci
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
| | | | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Hospital of Rome, Tor Vergata University, 00165 Rome, Italy
| | - Massimiliano Valeriani
- Developmental Neurology, Bambino Gesù Children Hospital, IRCCS, 00165 Rome, Italy
- Center for Sensory Motor Interaction, Aalborg University, 9220 Aalborg, Denmark
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Podkowa K, Czarnacki K, Borończyk A, Borończyk M, Paprocka J. The NMDA receptor antagonists memantine and ketamine as anti-migraine agents. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023:10.1007/s00210-023-02444-2. [PMID: 36869904 DOI: 10.1007/s00210-023-02444-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/22/2023] [Indexed: 03/05/2023]
Abstract
Migraine is a debilitating disorder affecting females more frequently than males. There is some evidence that drugs targeting glutamate receptors: memantine and ketamine might be beneficial in the therapy of this entity. Therefore, the purpose of this work is to present NMDA receptor antagonists, memantine and ketamine, as potential anti-migraine agents. We searched PubMed/MEDLINE, Embase, and clinical trials submitted to ClinicalTrials.gov to find publications describing eligible trials published between database inception and December 31, 2021. This comprehensive literature review summarizes data on the use of the NMDA receptor antagonists memantine and ketamine in the pharmacotherapy of migraine. Results from 20 previous and recent preclinical experiments are discussed and correlated with 19 clinical trials (including case series, open-label, and randomized placebo-controlled trials). For the purposes of this review, the authors hypothesized that the propagation of SD is a major mechanism in the pathophysiology of migraine. In several animal studies and in vitro studies, memantine and ketamine inhibited or reduced propagation of the SD. In addition, the results of clinical trials suggest that memantine or ketamine may be an effective treatment option for migraine. However, most studies on these agents lack control group. Although further clinical trials are needed, the results suggest that ketamine or memantine may be promising molecules for the treatment of severe migraine. Particular attention should be paid to people who have a treatment-resistant form of migraine with aura or have exhausted existing treatment options. For them, the drugs under discussion could represent an interesting alternative in the future.
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Affiliation(s)
- Karolina Podkowa
- Department of Pathophysiology, Jagiellonian University Medical College, Kraków, Poland.
| | - Kamil Czarnacki
- Students' Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Borończyk
- Students' Scientific Association, Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Borończyk
- Students' Scientific Association, Department of Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Spreading Depolarization as a Therapeutic Target in Severe Ischemic Stroke: Physiological and Pharmacological Strategies. J Pers Med 2022; 12:jpm12091447. [PMID: 36143232 PMCID: PMC9502975 DOI: 10.3390/jpm12091447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022] Open
Abstract
Background: Spreading depolarization (SD) occurs nearly ubiquitously in malignant hemispheric stroke (MHS) and is strongly implicated in edema progression and lesion expansion. Due to this high burden of SD after infarct, it is of great interest whether SD in MHS patients can be mitigated by physiologic or pharmacologic means and whether this intervention improves clinical outcomes. Here we describe the association between physiological variables and risk of SD in MHS patients who had undergone decompressive craniectomy and present an initial case of using ketamine to target SD in MHS. Methods: We recorded SD using subdural electrodes and time-linked with continuous physiological recordings in five subjects. We assessed physiologic variables in time bins preceding SD compared to those with no SD. Results: Using multivariable logistic regression, we found that increased ETCO2 (OR 0.772, 95% CI 0.655–0.910) and DBP (OR 0.958, 95% CI 0.941–0.991) were protective against SD, while elevated temperature (OR 2.048, 95% CI 1.442–2.909) and WBC (OR 1.113, 95% CI 1.081–1.922) were associated with increased risk of SD. In a subject with recurrent SD, ketamine at a dose of 2 mg/kg/h was found to completely inhibit SD. Conclusion: Fluctuations in physiological variables can be associated with risk of SD after MHS. Ketamine was also found to completely inhibit SD in one subject. These data suggest that use of physiological optimization strategies and/or pharmacologic therapy could inhibit SD in MHS patients, and thereby limit edema and infarct progression. Clinical trials using individualized approaches to target this novel mechanism are warranted.
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7
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Eighteen-hour inhibitory effect of s-ketamine on potassium- and ischemia-induced spreading depolarizations in the gyrencephalic swine brain. Neuropharmacology 2022; 216:109176. [DOI: 10.1016/j.neuropharm.2022.109176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/15/2022] [Accepted: 06/28/2022] [Indexed: 11/18/2022]
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8
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Telles JPM, Welling LC, Coelho ACSDS, Rabelo NN, Teixeira MJ, Figueiredo EG. Cortical spreading depolarization and ketamine: a short systematic review. Neurophysiol Clin 2021; 51:145-151. [PMID: 33610431 DOI: 10.1016/j.neucli.2021.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cortical spreading depolarization (SD) describes pathological waves characterized by an almost complete sustained depolarization of neurons and astrocytes that spreads throughout the cortex. In this study, we carried out a qualitative review of all available evidence, clinical and preclinical, on the use of ketamine in SD. METHODS We performed a systematic review of Medline, with no restrictions regarding publishing date or language, in search of articles reporting the use of ketamine in SD. The search string was composed of "ketamine," "spreading," "depolarization," and "depression" in both (AND) and (OR) combinations. RESULTS Twenty studies were included in the final synthesis. Many studies showed that ketamine effectively blocks SD in rats, swine, and humans. The first prospective randomized trial was published in 2018. Ten patients with severe traumatic brain injury or subarachnoid hemorrhage were enrolled, and ketamine showed a significant, dose-dependent effect on the reduction of SD. CONCLUSION The available evidence from preclinical studies is helping to translate the role of ketamine in blocking spreading depolarizations to clinical practice, in the settings of migraine with aura, traumatic brain injury, subarachnoid hemorrhage, and hemorrhagic and ischemic stroke. More randomized controlled trials are needed to determine whether interrupting the ketamine-blockable SDs effectively leads to an improvement in outcome and to assess the real occurrence of adverse effects.
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Affiliation(s)
- João Paulo Mota Telles
- Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Brazil
| | | | | | - Nícollas Nunes Rabelo
- Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Brazil
| | - Manoel Jacobsen Teixeira
- Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Brazil
| | - Eberval Gadelha Figueiredo
- Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Brazil.
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Schoknecht K, Kikhia M, Lemale CL, Liotta A, Lublinsky S, Mueller S, Boehm-Sturm P, Friedman A, Dreier JP. The role of spreading depolarizations and electrographic seizures in early injury progression of the rat photothrombosis stroke model. J Cereb Blood Flow Metab 2021; 41:413-430. [PMID: 32241203 PMCID: PMC7812510 DOI: 10.1177/0271678x20915801] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Spreading depolarization (SD) and seizures are pathophysiological events associated with cerebral ischemia. Here, we investigated their role for injury progression in the cerebral cortex. Cerebral ischemia was induced in anesthetized male Wistar rats using the photothrombosis (PT) stroke model. SD and spontaneous neuronal activity were recorded in the presence of either urethane or ketamine/xylazine anesthesia. Blood-brain barrier (BBB) permeability, cerebral perfusion, and cellular damage were assessed through a cranial window and repeated intravenous injection of fluorescein sodium salt and propidium iodide until 4 h after PT. Neuronal injury and early lesion volume were quantified by stereological cell counting and manual and automated assessment of ex vivo T2-weighted magnetic resonance imaging. Onset SDs originated at the thrombotic core and invaded neighboring cortex, whereas delayed SDs often showed opposite propagation patterns. Seizure induction by 4-aminopyridine caused no increase in lesion volume or neuronal injury in urethane-anesthetized animals. Ketamine/xylazine anesthesia was associated with a lower number of onset SDs, reduced lesion volume, and neuronal injury despite a longer duration of seizures. BBB permeability increase inversely correlated with the number of SDs at 3 and 4 h after PT. Our results provide further evidence that ketamine may counteract the early progression of ischemic injury.
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Affiliation(s)
- Karl Schoknecht
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Neuroscience Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Institute for Neurophysiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Carl-Ludwig-Institute for Physiology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Majed Kikhia
- Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Coline L Lemale
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Agustin Liotta
- Neuroscience Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Institute for Neurophysiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Anesthesiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Svetlana Lublinsky
- Departments of Physiology & Cell Biology, Cognitive & Brain Sciences, the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Susanne Mueller
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philipp Boehm-Sturm
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,NeuroCure Cluster of Excellence and Charité Core Facility 7T Experimental MRIs, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alon Friedman
- Departments of Physiology & Cell Biology, Cognitive & Brain Sciences, the Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Department of Medical Neuroscience, Dalhousie University, Halifax, Canada
| | - Jens P Dreier
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Experimental Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Bernstein Center for Computational Neuroscience Berlin, Humboldt-Universität zu Berlin, Germany
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10
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Herreras O, Makarova J. Mechanisms of the negative potential associated with Leão's spreading depolarization: A history of brain electrogenesis. J Cereb Blood Flow Metab 2020; 40:1934-1952. [PMID: 32580670 PMCID: PMC7786845 DOI: 10.1177/0271678x20935998] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 12/16/2022]
Abstract
Spreading depolarization (SD) is a self-propagated wave that provokes transient disorder of numerous cell and tissue functions, and that may kill neurons in metabolically compromised tissue. We examined the mechanisms underlying the main hallmark of SD, a giant extracellular potential (ΔVo) for which multiple electromotive forces have been proposed. The end-point is that neurons and not glia, dendritic channels and not spatial currents, and increased sodium conductance rather than potassium gradients, appear to be the main actors in the generation of the negative ΔVo. Neuronal currents are established by two mechanisms, a voltage independent dendritic current, and the differential polarization along the neuron membranes. Notably, despite of a marked drop of ion gradients, these evolve significantly during SD, and yet the membrane potential remains clamped at zero no matter how much inward current is present. There may be substantial inward current or none in function of the evolving portion of the neuron dendrites with SD-activated channels. We propose that the ΔVo promotes swelling-induced dendritic damage. Understanding SD electrogenesis requires all elements relevant for membrane potential, action currents, field potentials and volume conduction to be jointly considered, and it has already encouraged the search for new targets to limit SD-related pathology.
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Affiliation(s)
- Oscar Herreras
- Department of Translational Neuroscience, Cajal Institute – CSIC, Madrid, Spain
| | - Julia Makarova
- Department of Translational Neuroscience, Cajal Institute – CSIC, Madrid, Spain
- Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
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11
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Rouleau N, Bonzanni M, Erndt-Marino JD, Sievert K, Ramirez CG, Rusk W, Levin M, Kaplan DL. A 3D Tissue Model of Traumatic Brain Injury with Excitotoxicity That Is Inhibited by Chronic Exposure to Gabapentinoids. Biomolecules 2020; 10:E1196. [PMID: 32824600 PMCID: PMC7463727 DOI: 10.3390/biom10081196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/16/2022] Open
Abstract
Injury progression associated with cerebral laceration is insidious. Following the initial trauma, brain tissues become hyperexcitable, begetting further damage that compounds the initial impact over time. Clinicians have adopted several strategies to mitigate the effects of secondary brain injury; however, higher throughput screening tools with modular flexibility are needed to expedite mechanistic studies and drug discovery that will contribute to the enhanced protection, repair, and even the regeneration of neural tissues. Here we present a novel bioengineered cortical brain model of traumatic brain injury (TBI) that displays characteristics of primary and secondary injury, including an outwardly radiating cell death phenotype and increased glutamate release with excitotoxic features. DNA content and tissue function were normalized by high-concentration, chronic administrations of gabapentinoids. Additional experiments suggested that the treatment effects were likely neuroprotective rather than regenerative, as evidenced by the drug-mediated decreases in cell excitability and an absence of drug-induced proliferation. We conclude that the present model of traumatic brain injury demonstrates validity and can serve as a customizable experimental platform to assess the individual contribution of cell types on TBI progression, as well as to screen anti-excitotoxic and pro-regenerative compounds.
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Affiliation(s)
- Nicolas Rouleau
- Department of Biomedical Engineering, Science and Technology Center, 4 Colby Street, School of Engineering, Tufts University, Medford, MA 02155, USA; (N.R.); (M.B.); (J.D.E.-M.); (K.S.); (C.G.R.); (W.R.)
- Department of Biomedical Engineering, Initiative for Neural Science, Disease, and Engineering (INSciDE), Science & Engineering Complex, 200 College Avenue, Tufts University, Medford, MA 02155, USA
- Department of Biology, Allen Discovery Center at Tufts University, Science & Engineering Complex, 200 College, Avenue, Medford, MA 021553, USA;
| | - Mattia Bonzanni
- Department of Biomedical Engineering, Science and Technology Center, 4 Colby Street, School of Engineering, Tufts University, Medford, MA 02155, USA; (N.R.); (M.B.); (J.D.E.-M.); (K.S.); (C.G.R.); (W.R.)
- Department of Biomedical Engineering, Initiative for Neural Science, Disease, and Engineering (INSciDE), Science & Engineering Complex, 200 College Avenue, Tufts University, Medford, MA 02155, USA
- Department of Biology, Allen Discovery Center at Tufts University, Science & Engineering Complex, 200 College, Avenue, Medford, MA 021553, USA;
| | - Joshua D. Erndt-Marino
- Department of Biomedical Engineering, Science and Technology Center, 4 Colby Street, School of Engineering, Tufts University, Medford, MA 02155, USA; (N.R.); (M.B.); (J.D.E.-M.); (K.S.); (C.G.R.); (W.R.)
- Department of Biomedical Engineering, Initiative for Neural Science, Disease, and Engineering (INSciDE), Science & Engineering Complex, 200 College Avenue, Tufts University, Medford, MA 02155, USA
- Department of Biology, Allen Discovery Center at Tufts University, Science & Engineering Complex, 200 College, Avenue, Medford, MA 021553, USA;
| | - Katja Sievert
- Department of Biomedical Engineering, Science and Technology Center, 4 Colby Street, School of Engineering, Tufts University, Medford, MA 02155, USA; (N.R.); (M.B.); (J.D.E.-M.); (K.S.); (C.G.R.); (W.R.)
| | - Camila G. Ramirez
- Department of Biomedical Engineering, Science and Technology Center, 4 Colby Street, School of Engineering, Tufts University, Medford, MA 02155, USA; (N.R.); (M.B.); (J.D.E.-M.); (K.S.); (C.G.R.); (W.R.)
| | - William Rusk
- Department of Biomedical Engineering, Science and Technology Center, 4 Colby Street, School of Engineering, Tufts University, Medford, MA 02155, USA; (N.R.); (M.B.); (J.D.E.-M.); (K.S.); (C.G.R.); (W.R.)
| | - Michael Levin
- Department of Biology, Allen Discovery Center at Tufts University, Science & Engineering Complex, 200 College, Avenue, Medford, MA 021553, USA;
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - David L. Kaplan
- Department of Biomedical Engineering, Science and Technology Center, 4 Colby Street, School of Engineering, Tufts University, Medford, MA 02155, USA; (N.R.); (M.B.); (J.D.E.-M.); (K.S.); (C.G.R.); (W.R.)
- Department of Biomedical Engineering, Initiative for Neural Science, Disease, and Engineering (INSciDE), Science & Engineering Complex, 200 College Avenue, Tufts University, Medford, MA 02155, USA
- Department of Biology, Allen Discovery Center at Tufts University, Science & Engineering Complex, 200 College, Avenue, Medford, MA 021553, USA;
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12
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Kentar M, Mann M, Sahm F, Olivares-Rivera A, Sanchez-Porras R, Zerelles R, Sakowitz OW, Unterberg AW, Santos E. Detection of spreading depolarizations in a middle cerebral artery occlusion model in swine. Acta Neurochir (Wien) 2020; 162:581-592. [PMID: 31940093 DOI: 10.1007/s00701-019-04132-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/04/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND The main objective of this study was to generate a hemodynamically stable swine model to detect spreading depolarizations (SDs) using electrocorticography (ECoG) and intrinsic optical signal (IOS) imaging and laser speckle flowmetry (LSF) after a 30-h middle cerebral artery (MCA) occlusion (MCAo) in German Landrace Swine. METHODS A total of 21 swine were used. The study comprised a training group (group 1, n = 7), a group that underwent bilateral craniectomy and MCAo (group 2, n = 10) and a group used for 2,3,5-triphenyltetrazolium (TTC) staining (group 3, n = 5). RESULTS In group 2, nine animals that underwent MCAo survived for 30 h, and one animal survived for 12 h. We detected MCA variants with 2 to 4 vessels. In all cases, all of the MCAs were occluded. The intensity changes exhibited by IOS and LSF after clipping were closely correlated and indicated a lower blood volume and reduced blood flow in the middle cerebral artery territory. Using IOS, we detected a mean of 2.37 ± (STD) 2.35 SDs/h. Using ECoG, we detected a mean of 0.29 ± (STD) 0.53 SDs/h. Infarctions were diagnosed using histological analysis. TTC staining in group 3 confirmed that the MCA territory was compromised and that the anterior and posterior cerebral arteries were preserved. CONCLUSIONS We confirm the reliability of performing live monitoring of cerebral infarctions using our MCAo protocol to detect SDs.
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13
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Soldozy S, Sharifi KA, Desai B, Giraldo D, Yeghyayan M, Liu L, Norat P, Sokolowski JD, Yağmurlu K, Park MS, Tvrdik P, Kalani MYS. Cortical Spreading Depression in the Setting of Traumatic Brain Injury. World Neurosurg 2019; 134:50-57. [PMID: 31655239 DOI: 10.1016/j.wneu.2019.10.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 12/31/2022]
Abstract
Cortical spreading depression (CSD) is a pathophysiologic phenomenon that describes an expanding wave of depolarization within the cortical gray matter. Originally described over 70 years ago, this spreading depression disrupts neuronal and glial ionic equilibrium, leading to increased energy demands that can cause a metabolic crisis. This results in secondary insult, further perpetuating brain injury and neuronal death. Initially not thought to be of clinical significance, the view of CSD was modified with the advent of intracranial electroencephalography, or electrocorticography. With these improved monitoring techniques, CSD has been identified as a major mechanism by which traumatic brain injury (TBI) imparts its negative sequalae. TBI is a heterogenous disease process that runs the gamut of clinical presentations. This includes concussion, epidural and subdural hematoma, diffuse axonal injury, and subarachnoid hemorrhage. Nonetheless, CSD appears to be frequently occurring among the various types of TBI, thus allowing for the potential development of targeted therapies in an otherwise ill-fated patient cohort. Although a complete understanding of the interplay between CSD and TBI has not yet been achieved, the authors recount the efforts that have been employed over the last several decades in an effort to bridge this gap. In addition, our current understanding of the role neuroimmune cells play in CSD is discussed in the context of TBI. Finally, current therapeutic strategies using CSD as a pharmacologic target are explored with respect to their clinical use in patients with TBI.
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Affiliation(s)
- Sauson Soldozy
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Khadijeh A Sharifi
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Neuroscience, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Bhargav Desai
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Daniel Giraldo
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Michelle Yeghyayan
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Lei Liu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Neuroscience, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Pedro Norat
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jennifer D Sokolowski
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Kaan Yağmurlu
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Min S Park
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Petr Tvrdik
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Neuroscience, University of Virginia Health System, Charlottesville, Virginia, USA
| | - M Yashar S Kalani
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA; Department of Neuroscience, University of Virginia Health System, Charlottesville, Virginia, USA.
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14
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Benish T, Villalobos D, Love S, Casmaer M, Hunter CJ, Summers SM, April MD. The THINK (Treatment of Headache with Intranasal Ketamine) Trial: A Randomized Controlled Trial Comparing Intranasal Ketamine with Intravenous Metoclopramide. J Emerg Med 2019; 56:248-257.e1. [DOI: 10.1016/j.jemermed.2018.12.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 11/26/2018] [Accepted: 12/08/2018] [Indexed: 11/26/2022]
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15
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Sakurai A. Sedation and Analgesia for Patients with Acute Brain Injury. Neurocrit Care 2019. [DOI: 10.1007/978-981-13-7272-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Hobbs CN, Johnson JA, Verber MD, Mark Wightman R. An implantable multimodal sensor for oxygen, neurotransmitters, and electrophysiology during spreading depolarization in the deep brain. Analyst 2018; 142:2912-2920. [PMID: 28715004 DOI: 10.1039/c7an00508c] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Brain tissue injury is often accompanied by spreading depolarization (SD) events, marked by widespread cellular depolarization and cessation of neuronal firing. SD recruits viable tissue into the lesion, making it a focus for intervention. During SD, drastic fluctuations occur in ion gradients, extracellular neurotransmitter concentrations, cellular metabolism, and cerebral blood flow. Measuring SD requires a multimodal approach to capture the array of changes. However, the use of multiple sensors can inflict tissue damage. Here, we use carbon-fiber microelectrodes to characterize several aspects of SD with a single, minimally invasive sensor in the deep brain region of the nucleus accumbens. Fast-scan cyclic voltammetry detects large changes in oxygen, which reflect the balance between cerebral blood flow and energy consumption, and also supraphysiological release of electroactive neurotransmitters (i.e., dopamine). We verify waves of SD with concurrent single-unit or DC potential electrophysiological recordings. The single-unit recordings reveal bursts of action potentials followed by inactivity. The DC potentials exhibit a slow negative voltage shift in the extracellular space indicative of wide-spread cellular depolarization. Here, we characterize the multiple modalities of our sensor and demonstrate its utility for improved SD recordings.
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Affiliation(s)
- Caddy N Hobbs
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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17
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Klass A, Sánchez-Porras R, Santos E. Systematic review of the pharmacological agents that have been tested against spreading depolarizations. J Cereb Blood Flow Metab 2018; 38:1149-1179. [PMID: 29673289 PMCID: PMC6434447 DOI: 10.1177/0271678x18771440] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Spreading depolarization (SD) occurs alongside brain injuries and it can lead to neuronal damage. Therefore, pharmacological modulation of SD can constitute a therapeutic approach to reduce its detrimental effects and to improve the clinical outcome of patients. The major objective of this article was to produce a systematic review of all the drugs that have been tested against SD. Of the substances that have been examined, most have been shown to modulate certain SD characteristics. Only a few have succeeded in significantly inhibiting SD. We present a variety of strategies that have been proposed to overcome the notorious harmfulness and pharmacoresistance of SD. Information on clinically used anesthetic, sedative, hypnotic agents, anti-migraine drugs, anticonvulsants and various other substances have been compiled and reviewed with respect to the efficacy against SD, in order to answer the question of whether a drug at safe doses could be of therapeutic use against SD in humans.
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Affiliation(s)
- Anna Klass
- Neurosurgery Department, University of Heidelberg, Heidelberg, Germany
| | | | - Edgar Santos
- Neurosurgery Department, University of Heidelberg, Heidelberg, Germany
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18
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The role of nutrients in the pathogenesis and treatment of migraine headaches: Review. Biomed Pharmacother 2018; 102:317-325. [DOI: 10.1016/j.biopha.2018.03.059] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 12/28/2022] Open
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Carlson AP, Abbas M, Alunday RL, Qeadan F, Shuttleworth CW. Spreading depolarization in acute brain injury inhibited by ketamine: a prospective, randomized, multiple crossover trial. J Neurosurg 2018; 130:1513-1519. [PMID: 29799344 PMCID: PMC6279620 DOI: 10.3171/2017.12.jns171665] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/14/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Retrospective clinical data and case studies support a therapeutic effect of ketamine in suppression of spreading depolarization (SD) following brain injury. Preclinical data strongly support efficacy in terms of frequency of SD as well as recovery from electrocorticography (ECoG) depression. The authors present the results of the first prospective controlled clinical trial testing the role of ketamine used for clinical sedation on occurrence of SD. METHODS Ten patients with severe traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (SAH) were recruited for this pilot trial. A standard ECoG strip was placed at the time of craniotomy, and the patients were then placed on an alternating every-6-hour schedule of ketamine or other sedation agent. The order of treatment was randomized. The ketamine dose was adjusted to clinical effect or maintained at a subanesthetic basal dose (0.1 mg/kg/hr) if no sedation was required. SD was scored using standard criteria, blinded to ketamine dosing. Occurrence of SD was compared with the hourly dose of ketamine to determine the effect of ketamine on SD occurrence. RESULTS Successful ECoG recordings were obtained in all 10 patients: 8 with SAH and 2 with TBI. There were a total of 1642 hours of observations with adequate ECoG: 833 hours off ketamine and 809 hours on ketamine. Analysis revealed a strong dose-dependent effect such that hours off ketamine or on doses of less than 1.15 mg/kg/hr were associated with an increased risk of SD compared with hours on doses of 1.15 mg/kg/hr or more (OR 13.838, 95% CI 1.99-1000). This odds ratio decreased with lower doses of 1.0 mg/kg/hr (OR 4.924, 95% CI 1.337-43.516), 0.85 mg/kg/hr (OR 3.323, 95% CI 1.139-16.074), and 0.70 mg/kg/hr (OR 2.725, 95% CI 1.068-9.898) to a threshold of no effect at 0.55 mg/kg/hr (OR 1.043, 95% CI 0.565-2.135). When all ketamine data were pooled (i.e., on ketamine at any dose vs off ketamine), a nonsignificant overall trend toward less SD during hours on ketamine (χ2 = 3.86, p = 0.42) was observed. CONCLUSIONS Ketamine effectively inhibits SD over a wide range of doses commonly used for sedation, even in nonintubated patients. These data also provide the first prospective evidence that the occurrence of SD can be influenced by clinical intervention and does not simply represent an unavoidable epiphenomenon after injury. These data provide the basis for future studies assessing clinical improvement with SD-directed therapy.Clinical trial registration no.: NCT02501941 (clinicaltrials.gov).
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Affiliation(s)
- Andrew P. Carlson
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Mohammad Abbas
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Robert L. Alunday
- Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Fares Qeadan
- Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - C. William Shuttleworth
- Department of Neurosciences, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Ferrari A, Rustichelli C, Baraldi C. Glutamate receptor antagonists with the potential for migraine treatment. Expert Opin Investig Drugs 2017; 26:1321-1330. [PMID: 29050521 DOI: 10.1080/13543784.2017.1395411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Preclinical, clinical, and other (e.g., genetic) evidence support the concept that migraine susceptibility may at least partially result from a glutamatergic system disorder. Therefore, the receptors of the glutamatergic system are considered relatively new targets for investigational drugs to treat migraine. Investigational and established glutamate receptor antagonists (GluRAs) have been shown to possess antinociceptive properties in preclinical models of trigeminovascular nociception and have been evaluated in clinical trials. This review focuses on preclinical and clinical studies of GluRAs for the treatment of migraine. Areas covered: A PubMed database search (from 1987 to December 2016) and a review of published studies on GluRAs in migraine were conducted. Expert opinion: All published clinical trials of investigational GluRAs have been unsuccessful in establishing benefit for acute migraine treatment. Clinical trial results contrast with the preclinical data, suggesting that glutamate (Glu) does not play a decisive role after the attack has already been triggered. These antagonists may instead be useful for migraine prophylaxis. Improving patient care requires further investigating and critically analyzing the role of Glu in migraine, designing experimental models to study more receptors and their corresponding antagonists, and identifying biomarkers to facilitate trials designed to target specific subgroups of migraine patients.
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Affiliation(s)
- Anna Ferrari
- a Unit of Medical Toxicology, Headache and Drug Abuse Centre; Department of Diagnostic, Clinical and Public Health Medicine , University of Modena and Reggio Emilia , Modena , Italy
| | - Cecilia Rustichelli
- b Department of Life Sciences , University of Modena and Reggio Emilia , Modena , Italy
| | - Carlo Baraldi
- a Unit of Medical Toxicology, Headache and Drug Abuse Centre; Department of Diagnostic, Clinical and Public Health Medicine , University of Modena and Reggio Emilia , Modena , Italy
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Sánchez-Porras R, Santos E, Schöll M, Kunzmann K, Stock C, Silos H, Unterberg AW, Sakowitz OW. Ketamine modulation of the haemodynamic response to spreading depolarization in the gyrencephalic swine brain. J Cereb Blood Flow Metab 2017; 37:1720-1734. [PMID: 27126324 PMCID: PMC5435283 DOI: 10.1177/0271678x16646586] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/17/2016] [Accepted: 03/20/2016] [Indexed: 11/16/2022]
Abstract
Spreading depolarization (SD) generates significant alterations in cerebral haemodynamics, which can have detrimental consequences on brain function and integrity. Ketamine has shown an important capacity to modulate SD; however, its impact on SD haemodynamic response is incompletely understood. We investigated the effect of two therapeutic ketamine dosages, a low-dose of 2 mg/kg/h and a high-dose of 4 mg/kg/h, on the haemodynamic response to SD in the gyrencephalic swine brain. Cerebral blood volume, pial arterial diameter and cerebral blood flow were assessed through intrinsic optical signal imaging and laser-Doppler flowmetry. Our findings indicate that frequent SDs caused a persistent increase in the baseline pial arterial diameter, which can lead to a diminished capacity to further dilate. Ketamine infused at a low-dose reduced the hyperemic/vasodilative response to SD; however, it did not alter the subsequent oligemic/vasoconstrictive response. This low-dose did not prevent the baseline diameter increase and the diminished dilative capacity. Only infusion of ketamine at a high-dose suppressed SD and the coupled haemodynamic response. Therefore, the haemodynamic response to SD can be modulated by continuous infusion of ketamine. However, its use in pathological models needs to be explored to corroborate its possible clinical benefit.
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Affiliation(s)
| | - Edgar Santos
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Schöll
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Kevin Kunzmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Christian Stock
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Humberto Silos
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas W Unterberg
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver W Sakowitz
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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Lauritzen M, Strong AJ. 'Spreading depression of Leão' and its emerging relevance to acute brain injury in humans. J Cereb Blood Flow Metab 2017; 37:1553-1570. [PMID: 27354095 PMCID: PMC5435290 DOI: 10.1177/0271678x16657092] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A new research field in translational neuroscience has opened as a result of the recognition since 2002 that "spreading depression of Leão" can be detected in many patients with acute brain injury, whether vascular and spontaneous, or traumatic in origin, as well as in those many individuals experiencing the visual (or sensorimotor) aura of migraine. In this review, we trace from their first description in rabbits through to their detection and study in migraine and the injured human brain, and from our personal perspectives, the evolution of understanding of the importance of spread of mass depolarisations in cerebral grey matter. Detection of spontaneous depolarisations occurring and spreading in the periphery or penumbra of experimental focal cortical ischemic lesions and of their adverse effects on the cerebral cortical microcirculation and on the tissue glucose and oxygen pools has led to clearer concepts of how ischaemic and traumatic lesions evolve in the injured human brain, and of how to seek to improve clinical management and outcome. Recognition of the likely fundamental significance of spreading depolarisations for this wide range of serious acute encephalopathies in humans provides a powerful case for a fresh examination of neuroprotection strategies.
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Affiliation(s)
- Martin Lauritzen
- 1 Department of Neuroscience and Pharmacology and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.,2 Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Anthony J Strong
- 3 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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23
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Schankin CJ, Viana M, Goadsby PJ. Persistent and Repetitive Visual Disturbances in Migraine: A Review. Headache 2016; 57:1-16. [DOI: 10.1111/head.12946] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Christoph J. Schankin
- Department of Neurology; Inselspital, Bern University Hospital, University of Bern; Bern Switzerland
- Department of Neurology; Grosshadern, University Hospital Munich, University of Munich; Munich Germany
| | - Michele Viana
- Headache Science Center, C. Mondino National Neurological Institute; Pavia Italy
| | - Peter J. Goadsby
- Headache Group, NIHR-Wellcome Trust King's Clinical Research Facility, King's College London; London United Kingdom
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Santos-Monteiro J, Teodósio N, Guedes R. Long-lasting Effects of Early Environmental Stimulation on Cortical Spreading Depression in Normal and Early Malnourished Adult Rats. Nutr Neurosci 2016; 3:29-40. [DOI: 10.1080/1028415x.2000.11747301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Suppression of Spreading Depression of Leão in Neocortex by an N-Methyl-D-Aspartate Receptor Antagonist. Can J Neurol Sci 2015. [DOI: 10.1017/s0317167100041688] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT:Spreading depression has been implicated in the pathophysiology of a number of diseases such as migraine, stroke and epilepsy. The characteristics of this phenomenon were explored in neocortex of anesthetized rats. Spreading depression was produced in 10 of 15 animals using mechanical, electrical and chemical stimulation. Mean amplitude of the DC shift was -9.3 mV, mean duration at any one electrode 65 sec and rate of spread 2-5 mm/min. Spreading depression was facilitated by focal interictal spike activity induced by penicillin and completely blocked by the N-methyl-D-aspartate (NMDA) receptor antagonist, DL-2-aminophosphonovaleric acid (APV), providing further evidence that excitatory amino acid neurotransmission is a critical element in the development or propagation of the phenomenon.
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de Souza TKM, E Silva-Gondim MB, Rodrigues MCA, Guedes RCA. Anesthetic agents modulate ECoG potentiation after spreading depression, and insulin-induced hypoglycemia does not modify this effect. Neurosci Lett 2015; 592:6-11. [PMID: 25681772 DOI: 10.1016/j.neulet.2015.02.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/23/2015] [Accepted: 02/07/2015] [Indexed: 12/15/2022]
Abstract
Cortical spreading depression (CSD) is characterized by reversible reduction of spontaneous and evoked electrical activity of the cerebral cortex. Experimental evidence suggests that CSD may modulate neural excitability and synaptic activity, with possible implications for long-term potentiation. Systemic factors like anesthetics and insulin-induced hypoglycemia can influence CSD propagation. In this study, we examined whether the post-CSD ECoG potentiation can be modulated by anesthetics and insulin-induced hypoglycemia. We found that awake adult rats displayed increased ECoG potentiation after CSD, as compared with rats under urethane+chloralose anesthesia or tribromoethanol anesthesia. In anesthetized rats, insulin-induced hypoglycemia did not modulate ECoG potentiation. Comparison of two cortical recording regions in awake rats revealed a similarly significant (p<0.05) potentiation effect in both regions, whereas in the anesthetized groups the potentiation was significant only in the recording region nearer to the stimulating point. Our data suggest that urethane+chloralose and tribromoethanol anesthesia modulate the post-CSD potentiation of spontaneous electrical activity in the adult rat cortex, and insulin-induced hypoglycemia does not modify this effect. Data may help to gain a better understanding of excitability-dependent mechanisms underlying CSD-related neurological diseases.
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How spreading depolarization can be the pathophysiological correlate of both migraine aura and stroke. ACTA NEUROCHIRURGICA. SUPPLEMENT 2015; 120:137-40. [PMID: 25366613 DOI: 10.1007/978-3-319-04981-6_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The term spreading depolarization describes a mechanism of abrupt, massive ion translocation between neurons and the interstitial space, which leads to a cytotoxic edema in the gray matter of the brain. In energy-compromised tissue, spreading depolarization is preceded by a nonspreading silencing (depression of spontaneous activity) because of a neuronal hyperpolarization. By contrast, in tissue that is not energy compromised, spreading depolarization is accompanied by a spreading silencing (spreading depression) of spontaneous activity caused by a depolarization block. It is assumed that the nonspreading silencing translates into the initial clinical symptoms of ischemic stroke and the spreading silencing (spreading depression) into the symptoms of migraine aura. In energy-compromised tissue, spreading depolarization facilitates neuronal death, whereas, in healthy tissue, it is relatively innocuous. Therapies targeting spreading depolarization in metabolically compromised tissue may potentially treat conditions of acute cerebral injury such as aneurysmal subarachnoid hemorrhage.
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Rat endovascular perforation model. Transl Stroke Res 2014; 5:660-8. [PMID: 25213427 DOI: 10.1007/s12975-014-0368-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/18/2014] [Accepted: 08/21/2014] [Indexed: 12/31/2022]
Abstract
Experimental animal models of aneurysmal subarachnoid hemorrhage (SAH) have provided a wealth of information on the mechanisms of brain injury. The rat endovascular perforation (EVP) model replicates the early pathophysiology of SAH and hence is frequently used to study early brain injury following SAH. This paper presents a brief review of historical development of the EVP model and details the technique used to create SAH and considerations necessary to overcome technical challenges.
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Sánchez-Porras R, Santos E, Schöll M, Stock C, Zheng Z, Schiebel P, Orakcioglu B, Unterberg AW, Sakowitz OW. The effect of ketamine on optical and electrical characteristics of spreading depolarizations in gyrencephalic swine cortex. Neuropharmacology 2014; 84:52-61. [DOI: 10.1016/j.neuropharm.2014.04.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/14/2014] [Accepted: 04/24/2014] [Indexed: 11/26/2022]
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Sun-Edelstein C, Mauskop A. Role of magnesium in the pathogenesis and treatment of migraine. Expert Rev Neurother 2014; 9:369-79. [DOI: 10.1586/14737175.9.3.369] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Costa C, Tozzi A, Rainero I, Cupini LM, Calabresi P, Ayata C, Sarchielli P. Cortical spreading depression as a target for anti-migraine agents. J Headache Pain 2013; 14:62. [PMID: 23879550 PMCID: PMC3728002 DOI: 10.1186/1129-2377-14-62] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/08/2013] [Indexed: 12/18/2022] Open
Abstract
Spreading depression (SD) is a slowly propagating wave of neuronal and glial depolarization lasting a few minutes, that can develop within the cerebral cortex or other brain areas after electrical, mechanical or chemical depolarizing stimulations. Cortical SD (CSD) is considered the neurophysiological correlate of migraine aura. It is characterized by massive increases in both extracellular K⁺ and glutamate, as well as rises in intracellular Na⁺ and Ca²⁺. These ionic shifts produce slow direct current (DC) potential shifts that can be recorded extracellularly. Moreover, CSD is associated with changes in cortical parenchymal blood flow. CSD has been shown to be a common therapeutic target for currently prescribed migraine prophylactic drugs. Yet, no effects have been observed for the antiepileptic drugs carbamazepine and oxcarbazepine, consistent with their lack of efficacy on migraine. Some molecules of interest for migraine have been tested for their effect on CSD. Specifically, blocking CSD may play an enabling role for novel benzopyran derivative tonabersat in preventing migraine with aura. Additionally, calcitonin gene-related peptide (CGRP) antagonists have been recently reported to inhibit CSD, suggesting the contribution of CGRP receptor activation to the initiation and maintenance of CSD not only at the classic vascular sites, but also at a central neuronal level. Understanding what may be lying behind this contribution, would add further insights into the mechanisms of actions for "gepants", which may be pivotal for the effectiveness of these drugs as anti-migraine agents. CSD models are useful tools for testing current and novel prophylactic drugs, providing knowledge on mechanisms of action relevant for migraine.
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Affiliation(s)
- Cinzia Costa
- Neurologic Clinic, Department of Public Health and Medical and Surgical Specialties, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06132, Perugia, Italy
- Fondazione Santa Lucia I.R.C.C.S., Via del Fosso di Fiorano, 00143, Rome, Italy
| | - Alessandro Tozzi
- Neurologic Clinic, Department of Public Health and Medical and Surgical Specialties, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06132, Perugia, Italy
- Fondazione Santa Lucia I.R.C.C.S., Via del Fosso di Fiorano, 00143, Rome, Italy
| | - Innocenzo Rainero
- Neurology II, Department of Neuroscience, University of Torino, Ospedale Molinette, Via Cherasco 15, 10126, Turin, Italy
| | | | - Paolo Calabresi
- Neurologic Clinic, Department of Public Health and Medical and Surgical Specialties, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06132, Perugia, Italy
- Fondazione Santa Lucia I.R.C.C.S., Via del Fosso di Fiorano, 00143, Rome, Italy
| | - Cenk Ayata
- Neurovascular Research Lab., Department of Radiology, Stroke Service and Neuroscience Intensive Unit Department of Neurology Massachusetts Hospital, Harvard Medical School, 02115, Boston, MA, USA
| | - Paola Sarchielli
- Neurologic Clinic, Department of Public Health and Medical and Surgical Specialties, University of Perugia, Ospedale Santa Maria della Misericordia, Sant'Andrea delle Fratte, 06132, Perugia, Italy
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Dreier JP, Victorov IV, Petzold GC, Major S, Windmüller O, Fernández-Klett F, Kandasamy M, Dirnagl U, Priller J. Electrochemical Failure of the Brain Cortex Is More Deleterious When it Is Accompanied by Low Perfusion. Stroke 2013; 44:490-6. [DOI: 10.1161/strokeaha.112.660589] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Clinical and experimental evidence suggests that spreading depolarization facilitates neuronal injury when its duration exceeds a certain time point, termed commitment point. We here investigated whether this commitment point is shifted to an earlier period, when spreading depolarization is accompanied by a perfusion deficit.
Methods—
Electrophysiological and cerebral blood flow changes were studied in a rat cranial window model followed by histological and immunohistochemical analyses of cortical damage.
Results—
In group 1, brain topical application of artificial cerebrospinal fluid (ACSF) with high K
+
concentration ([K
+
]
ACSF
) for 1 hour allowed us to induce a depolarizing event of fixed duration with cerebral blood flow fluctuations around the baseline (short-lasting initial hypoperfusions followed by hyperemia). In group 2, coapplication of the NO-scavenger hemoglobin ([Hb]
ACSF
) with high [K
+
]
ACSF
caused a depolarizing event of similar duration, to which a severe perfusion deficit was coupled (=spreading ischemia). In group 3, intravenous coadministration of the L-type calcium channel antagonist nimodipine with brain topical application of high [K
+
]
ACSF
/[Hb]
ACSF
caused spreading ischemia to revert to spreading hyperemia. Whereas scattered neuronal injury occurred in the superficial cortical layers in the window areas of groups 1 and 3, necrosis of all layers with partial loss of the tissue texture and microglial activation were observed in group 2.
Conclusions—
The results suggest that electrochemical failure of the cortex is more deleterious when it is accompanied by low perfusion. Thus, the commitment point of the cortex is not a universal value but depends on additional factors, such as the level of perfusion.
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Affiliation(s)
- Jens P. Dreier
- From the Center for Stroke Research Berlin (J.P.D., S.M., U.D.), Department of Experimental Neurology (J.P.D., S.M., G.C.P., O.W., U.D.), Department of Neurology (J.P.D., S.M., G.C.P.), Department of Neuropsychiatry (F.F.-K., M.K., J.P.), and Excellence Cluster NeuroCure (J.P.D., U.D., J.P.), Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, University of Bonn, Bonn, Germany (G.C.P.); and Laboratory of Experimental Neurocytology, Brain Research Institute, Moscow, Russia
| | - Ilya V. Victorov
- From the Center for Stroke Research Berlin (J.P.D., S.M., U.D.), Department of Experimental Neurology (J.P.D., S.M., G.C.P., O.W., U.D.), Department of Neurology (J.P.D., S.M., G.C.P.), Department of Neuropsychiatry (F.F.-K., M.K., J.P.), and Excellence Cluster NeuroCure (J.P.D., U.D., J.P.), Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, University of Bonn, Bonn, Germany (G.C.P.); and Laboratory of Experimental Neurocytology, Brain Research Institute, Moscow, Russia
| | - Gabor C. Petzold
- From the Center for Stroke Research Berlin (J.P.D., S.M., U.D.), Department of Experimental Neurology (J.P.D., S.M., G.C.P., O.W., U.D.), Department of Neurology (J.P.D., S.M., G.C.P.), Department of Neuropsychiatry (F.F.-K., M.K., J.P.), and Excellence Cluster NeuroCure (J.P.D., U.D., J.P.), Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, University of Bonn, Bonn, Germany (G.C.P.); and Laboratory of Experimental Neurocytology, Brain Research Institute, Moscow, Russia
| | - Sebastian Major
- From the Center for Stroke Research Berlin (J.P.D., S.M., U.D.), Department of Experimental Neurology (J.P.D., S.M., G.C.P., O.W., U.D.), Department of Neurology (J.P.D., S.M., G.C.P.), Department of Neuropsychiatry (F.F.-K., M.K., J.P.), and Excellence Cluster NeuroCure (J.P.D., U.D., J.P.), Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, University of Bonn, Bonn, Germany (G.C.P.); and Laboratory of Experimental Neurocytology, Brain Research Institute, Moscow, Russia
| | - Olaf Windmüller
- From the Center for Stroke Research Berlin (J.P.D., S.M., U.D.), Department of Experimental Neurology (J.P.D., S.M., G.C.P., O.W., U.D.), Department of Neurology (J.P.D., S.M., G.C.P.), Department of Neuropsychiatry (F.F.-K., M.K., J.P.), and Excellence Cluster NeuroCure (J.P.D., U.D., J.P.), Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, University of Bonn, Bonn, Germany (G.C.P.); and Laboratory of Experimental Neurocytology, Brain Research Institute, Moscow, Russia
| | - Francisco Fernández-Klett
- From the Center for Stroke Research Berlin (J.P.D., S.M., U.D.), Department of Experimental Neurology (J.P.D., S.M., G.C.P., O.W., U.D.), Department of Neurology (J.P.D., S.M., G.C.P.), Department of Neuropsychiatry (F.F.-K., M.K., J.P.), and Excellence Cluster NeuroCure (J.P.D., U.D., J.P.), Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, University of Bonn, Bonn, Germany (G.C.P.); and Laboratory of Experimental Neurocytology, Brain Research Institute, Moscow, Russia
| | - Mahesh Kandasamy
- From the Center for Stroke Research Berlin (J.P.D., S.M., U.D.), Department of Experimental Neurology (J.P.D., S.M., G.C.P., O.W., U.D.), Department of Neurology (J.P.D., S.M., G.C.P.), Department of Neuropsychiatry (F.F.-K., M.K., J.P.), and Excellence Cluster NeuroCure (J.P.D., U.D., J.P.), Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, University of Bonn, Bonn, Germany (G.C.P.); and Laboratory of Experimental Neurocytology, Brain Research Institute, Moscow, Russia
| | - Ulrich Dirnagl
- From the Center for Stroke Research Berlin (J.P.D., S.M., U.D.), Department of Experimental Neurology (J.P.D., S.M., G.C.P., O.W., U.D.), Department of Neurology (J.P.D., S.M., G.C.P.), Department of Neuropsychiatry (F.F.-K., M.K., J.P.), and Excellence Cluster NeuroCure (J.P.D., U.D., J.P.), Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, University of Bonn, Bonn, Germany (G.C.P.); and Laboratory of Experimental Neurocytology, Brain Research Institute, Moscow, Russia
| | - Josef Priller
- From the Center for Stroke Research Berlin (J.P.D., S.M., U.D.), Department of Experimental Neurology (J.P.D., S.M., G.C.P., O.W., U.D.), Department of Neurology (J.P.D., S.M., G.C.P.), Department of Neuropsychiatry (F.F.-K., M.K., J.P.), and Excellence Cluster NeuroCure (J.P.D., U.D., J.P.), Charité University Medicine Berlin, Berlin, Germany; Department of Neurology, University of Bonn, Bonn, Germany (G.C.P.); and Laboratory of Experimental Neurocytology, Brain Research Institute, Moscow, Russia
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Abadie-Guedes R, Guedes RCA, Bezerra RS. The impairing effect of acute ethanol on spreading depression is antagonized by astaxanthin in rats of 2 young-adult ages. Alcohol Clin Exp Res 2012; 36:1563-7. [PMID: 22432539 DOI: 10.1111/j.1530-0277.2012.01766.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 01/09/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ethanol (EtOH) abuse and insufficient ingestion of antioxidants are external factors that can alter brain electrophysiology. Our previous studies have demonstrated that the excitability-related brain electrophysiological phenomenon known as cortical spreading depression (CSD) was facilitated by chronic EtOH intake, and chronic treatment with carotenoids attenuated this effect. Here, we investigated the acute effect of a single EtOH administration on CSD in young and adult rats previously (1 hour) treated with 10 μg/kg of astaxanthin. METHODS Male Wistar rats (5 young- and 5 adult groups, 60 to 80 and 150 to 180 days of age, respectively) were treated by 2 gavage procedures at 1-hour interval as follows: groups 1 and 2 received astaxanthin in gavage I combined with EtOH (group 1) or water (group 2) in gavage II; groups 3 and 4 received olive oil (the vehicle in which astaxanthin was dissolved) in gavage I combined with EtOH (group 3) or water (group 4) in gavage II; group 5 received water in gavage I combined with EtOH in gavage II. CSD was recorded on the cortical surface for 4 hours. RESULTS Compared to the respective water and oil controls (groups 2 and 4; CSD velocities: 3.73 ± 0.09 and 3.78 ± 0.07 mm/min in the young groups; 2.99 ± 0.10 and 3.05 ± 0.19 mm/min in the adult groups), a single dose of EtOH (groups 3 and 5) decreased CSD propagation velocities (3.29 ± 0.23 and 3.16 ± 0.10 mm/min in the young groups; 2.71 ± 0.27 and 2.75 ± 0.31 mm/min in the adult groups). Astaxanthin antagonized the impairing effect of acute EtOH on CSD (group 1; mean velocity: 3.70 ± 0.19 and 3.13 ± 0.16 mm/min for the young and adult groups, respectively). CONCLUSIONS The results showed an antagonistic effect of acute EtOH treatment on CSD propagation that was reverted by astaxanthin. The EtOH-astaxanthin interaction was not influenced by the age, as it was found in both young and adult animals.
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Affiliation(s)
- Ricardo Abadie-Guedes
- Laboratório de Enzimologia-LABENZ, Departamento de Bioquímica, CCB, Universidade Federal de Pernambuco, Recife, PE, Brazil
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Bogdanov VB, Multon S, Chauvel V, Bogdanova OV, Prodanov D, Makarchuk MY, Schoenen J. Migraine preventive drugs differentially affect cortical spreading depression in rat. Neurobiol Dis 2010; 41:430-5. [PMID: 20977938 DOI: 10.1016/j.nbd.2010.10.014] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 10/10/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022] Open
Abstract
Cortical spreading depression (CSD) is the most likely cause of the migraine aura. Drugs with distinct pharmacological properties are effective in the preventive treatment of migraine. To test the hypothesis that their common denominator might be suppression of CSD we studied in rats the effect of three drugs used in migraine prevention: lamotrigine which is selectively effective on the aura but not on the headache, valproate and riboflavin which have a non-selective effect. Rats received for 4 weeks daily intraperitoneal injections of one of the three drugs. For valproate and riboflavin we used saline as control, for lamotrigine its vehicle dimethyl sulfoxide. After treatment, cortical spreading depressions were elicited for 2h by occipital KCl application. We measured CSD frequency, its propagation between a posterior (parieto-occipital) and an anterior (frontal) electrode, and number of Fos-immunoreactive nuclei in frontal cortex. Lamotrigine suppressed CSDs by 37% and 60% at posterior and anterior electrodes. Valproate had no effect on posterior CSDs, but reduced anterior ones by 32% and slowed propagation velocity. Riboflavin had no significant effect at neither recording site. Frontal Fos expression was decreased after lamotrigine and valproate, but not after riboflavin. Serum levels of administered drugs were within the range of those usually effective in patients. Our study shows that preventive anti-migraine drugs have differential effects on CSD. Lamotrigine has a marked suppressive effect which correlates with its rather selective action on the migraine aura. Valproate and riboflavin have no effect on the triggering of CSD, although they are effective in migraine without aura. Taken together, these results are compatible with a causal role of CSD in migraine with aura, but not in migraine without aura.
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Affiliation(s)
- Volodymyr Borysovych Bogdanov
- Headache Research Unit, GIGA-Neurosciences and Department of Neurology, Liège University, CHU Sart Tilman B36, T4, +1, B-4000, Liège, Belgium
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Abstract
Despite the relatively well-characterized headache mechanisms in migraine, upstream events triggering individual attacks are poorly understood. This lack of mechanistic insight has hampered a rational approach to prophylactic drug discovery. Unlike targeted abortive and analgesic interventions, mainstream migraine prophylaxis has been largely based on serendipitous observations (e.g. propranolol) and presumed class effects (e.g. anticonvulsants). Recent studies suggest that spreading depression is the final common pathophysiological target for several established or investigational migraine prophylactic drugs. Building on these observations, spreading depression can now be explored for its predictive utility as a preclinical drug screening paradigm in migraine prophylaxis.
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Affiliation(s)
- C Ayata
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Exposure of developing well-nourished and malnourished rats to environmental heating facilitates cortical spreading depression propagation at adulthood. Neurosci Lett 2009; 454:218-22. [DOI: 10.1016/j.neulet.2009.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2008] [Revised: 02/22/2009] [Accepted: 03/11/2009] [Indexed: 11/23/2022]
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39
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Frazão MF, Silva de Seixas Maia LM, Guedes RCA. Early malnutrition, but not age, modulates in the rat the l-Arginine facilitating effect on cortical spreading depression. Neurosci Lett 2008; 447:26-30. [DOI: 10.1016/j.neulet.2008.09.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2008] [Revised: 09/25/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
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40
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Abadie-Guedes R, Santos SD, Cahú TB, Guedes RCA, de Souza Bezerra R. Dose-Dependent Effects of Astaxanthin on Cortical Spreading Depression in Chronically Ethanol-Treated Adult Rats. Alcohol Clin Exp Res 2008; 32:1417-21. [DOI: 10.1111/j.1530-0277.2008.00710.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kudo C, Nozari A, Moskowitz MA, Ayata C. The impact of anesthetics and hyperoxia on cortical spreading depression. Exp Neurol 2008; 212:201-6. [PMID: 18501348 PMCID: PMC2459317 DOI: 10.1016/j.expneurol.2008.03.026] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 03/15/2008] [Accepted: 03/31/2008] [Indexed: 11/16/2022]
Abstract
Cortical spreading depression (CSD), a transient neuronal and glial depolarization that propagates slowly across the cerebral cortex, is the putative electrophysiological event underlying migraine aura. It negatively impacts tissue injury during stroke, cerebral contusion and intracranial hemorrhage. Susceptibility to CSD has been assessed in several experimental animal models in vivo, such as after topical KCl application or cathodal stimulation. Various combinations of anesthetics and ambient conditions have been used by different laboratories making comparisons problematic and differences in data difficult to reconcile. We systematically studied CSD susceptibility comparing commonly used experimental anesthetics (isoflurane, alpha-chloralose, and urethane) with or without N(2)O or normobaric hyperoxia (100% O(2) inhalation). The frequency of evoked CSDs, and their propagation speed, duration, and amplitude were recorded during 2 h topical KCl (1 M) application. We found that N(2)O reduced CSD frequency when combined with isoflurane or urethane, but not alpha-chloralose; N(2)O also decreased CSD propagation speed and duration. Urethane anesthesia was associated with the highest CSD frequency that was comparable to pentobarbital. Inhalation of 100% O(2) did not alter CSD frequency, propagation speed or duration in combination with any of the anesthetics tested. Our data show anesthetic modulation of CSD susceptibility in an experimental model of human disease, underscoring the importance of proper study design for hypothesis testing as well as for comparing results between studies.
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Affiliation(s)
- Chiho Kudo
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129
| | - Ala Nozari
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129
| | - Michael A. Moskowitz
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129
| | - Cenk Ayata
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129
- Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129
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Rowland NC, Jaeger D. Responses to tactile stimulation in deep cerebellar nucleus neurons result from recurrent activation in multiple pathways. J Neurophysiol 2007; 99:704-17. [PMID: 18077662 DOI: 10.1152/jn.01100.2007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In a previous study, we found that neurons in the deep cerebellar nuclei (DCN) respond to 5-ms brief facial tactile stimulation in rats anesthetized with ketamine-xylazine with multiphasic response patterns lasting over 200 ms. It remained unclear, however, to what extent these responses were shaped not only by ascending sensory input from the trigeminal nuclei but also by interactions with other major cerebellar afferent systems, in particular the inferior olive (IO) and cerebral cortex. In the present study, we recorded from the IO, cerebral cortex, cerebellar granule cell layer (GCL), and DCN during the presentation of 5-ms facial tactile stimuli to elucidate potential mechanisms of how extended DCN response patterns are generated. We found that tactile stimulation resulted in robust multiphasic local field potentials responses in the IO as well as in the activation of a wide region of the somatosensory cortex (SI) and the primary motor cortex (MI). DCN neurons responded to electrical stimulation of any of these structures (IO, SI, and MI) with complex temporal patterns strikingly similar to air-puff lip stimulation responses. Simultaneous recordings from multiple structures revealed that long-lasting activation patterns elicited in DCN neurons were based on recurrent network activation in particular between the IO and the DCN with a potential contribution of DCN rebound properties. These results are consistent with the hypothesis that sensory stimulation triggers a feedback network activation of cerebellum, IO, and cerebral cortex to generate temporal patterns of activity that may control the timing of behavior.
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Sachs M, Pape HC, Speckmann EJ, Gorji A. The effect of estrogen and progesterone on spreading depression in rat neocortical tissues. Neurobiol Dis 2007; 25:27-34. [PMID: 17008106 DOI: 10.1016/j.nbd.2006.08.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2006] [Revised: 08/07/2006] [Accepted: 08/15/2006] [Indexed: 11/21/2022] Open
Abstract
Although gender differences in the incidence of migraine with aura appear to be related to high circulating levels of ovarian hormones, the underlying mechanisms are not yet fully understood. Several studies have suggested a major role for spreading depression (SD) in the pathogenesis and symptomatology of migraine with aura. To investigate a possible role of SD in the association of high female hormones and attacks of migraine with aura, the effects of beta-estradiol and progesterone on SD were studied in rat neocortical tissues. Application of both hormones enhanced the repetition rate as well as the amplitude of SD in neocortical slices treated with hypotonic artificial cerebrospinal fluid. beta-Estradiol and progesterone also dose dependently increased the amplitude of SD induced by KCl microinjection. Both hormones exhibited a pronounced, persisting, and significant enhancement of long-term potentiation of the field excitatory postsynaptic potential in the neocortical tissues. The changes in SD characteristics in the presence of estrogen and progesterone may responsible for increased migraine with aura attacks associated by high female hormones. These hormones may exert their effects on SD via facilitation of synaptic transmission.
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Affiliation(s)
- Martin Sachs
- Institut für Physiologie I, Westfälische Wilhelms-Universität Münster, Robert-Koch-Strasse 27a, 48149 Münster, Germany
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dos Santos AA, Pinheiro PCF, de Lima DSC, Ozias MG, de Oliveira MB, Guimarães NX, Guedes RCA. Fluoxetine inhibits cortical spreading depression in weaned and adult rats suckled under favorable and unfavorable lactation conditions. Exp Neurol 2006; 200:275-82. [PMID: 16616920 DOI: 10.1016/j.expneurol.2006.02.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 02/09/2006] [Accepted: 02/13/2006] [Indexed: 10/24/2022]
Abstract
Wistar rats (n = 58) were injected subcutaneously during the lactation period with fluoxetine (5, 10, 20 or 40 mg/kg/day) and cortical spreading depression (SD) was recorded immediately after weaning (25-30 days of life). An additional group (10 mg/kg; n = 8) was SD-recorded at 60-70 days. As compared to the saline-injected (n = 24) or "ingenuous" (n = 16) controls, fluoxetine dose-dependently reduced (P < 0.05) SD-velocities in the young rats by 4, 6, 16 and 15%, respectively, and in adult rats by 13%. In another experiment (26 adult rats), topical cortical application of fluoxetine (5 and 10 mg/ml solutions over the intact dura-mater for 10 min; n = 12 and 14, respectively) dose-dependently reduced SD-velocity (7.6% and 43.3% maximal reductions; P < 0.05). SD-propagation was blocked in 4 out of the 14 W-rats topically treated with the highest fluoxetine concentration (10 mg/ml). This topical fluoxetine effect was reverted after flushing the treated region with saline. In additional, 58 early-malnourished rats, fluoxetine applied during the suckling period (10 mg/kg/day, s.c.) and topically (10 mg/ml) also reduced (P < 0.05) SD-velocities by 18 and 22% for the systemic treatment (young and adult animals, respectively) and by 22.4% for the topical one. The present fluoxetine action supports the hypothesis of an antagonistic serotoninergic influence on SD, as previously suggested in experiments using other serotoninergic drugs. Data also suggest that early malnutrition does not greatly affect fluoxetine effects on SD.
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Sonn J, Mayevsky A. Effects of anesthesia on the responses to cortical spreading depression in the rat brain in vivo. Neurol Res 2006; 28:206-19. [PMID: 16551442 DOI: 10.1179/016164105x49445] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect of cortical spreading depression (CSD) on the metabolic, hemodynamic, electrical and ionic properties during anesthesia as compared with the awake state. METHODS The mitochondrial NADH redox state, reflected light, direct current (DC) potential, electrocorticography (ECoG), cerebral blood flow (CBF) and volume (CBV), and extracellular K(+) concentrations ([K(+)](e)), were measured continuously and simultaneously in real time using two unique monitoring systems that evaluate brain function. Three consecutive CSD waves were initiated using a KCl solution in both awake and anesthetized rats. RESULTS AND DISCUSSION CSD caused typical amplitude changes: biphasic waves in reflectance, oxidation cycles in NADH, an increase in CBF, CBV and in [K(+)](e), a negative shift in DC potential and depression in ECoG. Anesthesia by equithesin decreased significantly the baseline levels of CBF and [K(+)](e), showing a reduction in oxygen supply and demand. After anesthesia, CSD significantly decreased [K(+)](e) and NADH oxidation cycles, indicating a reduction in oxygen demand and in oxygen balance, respectively. Furthermore, anesthesia reduced CSD wave frequencies by slowing the recovery period, showing a decline in energy production during brain activation, or by changing electrophysiological properties of the tissue. No changes were found in the propagation rate and in the initiation period of CSD, which may indicate that equithesin does not block CSD initiation. In addition, we found that the whole cerebral cortex reacts homogenously to CSD and that equithesin may reduce oxygen demand and energy production, which may have a protective effect on the brain exposed to pathophysiological conditions.
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Affiliation(s)
- Judith Sonn
- Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan 52900, Israel.
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Haerter K, Ayata C, Moskowitz MA. Cortical Spreading Depression: A Model for Understanding Migraine Biology and Future Drug Targets. ACTA ACUST UNITED AC 2005. [DOI: 10.1111/j.1743-5013.2005.00017.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Strong AJ, Dardis R. Depolarisation phenomena in traumatic and ischaemic brain injury. Adv Tech Stand Neurosurg 2005; 30:3-49. [PMID: 16350451 DOI: 10.1007/3-211-27208-9_1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
1. Cortical spreading depression is a non-physiological global depolarisation of neurones and astrocytes that can be initiated with varying degrees of difficulty in the normally perfused cerebral cortex in the experimental laboratory. Induction is typically with electrical stimulation, needling of the cerebral cortex, or superfusion of isotonic or more concentrated potassium chloride solution. The phenomenon propagates across the cerebral cortex at a rate of 2-5 mm per minute, and is accompanied by marked but transient increases in cerebral blood flow, in local tissue oxygen tension, and most probably in metabolic rate. 2. Peri-infarct depolarisation is also a depolarisation event affecting neurones and glia, with an electrophysiological basis similar or identical to CSD, but occurring spontaneously in the ischaemic penumbra or boundary zone in focal cerebral cortical ischaemia. Most such events arise from the edge of the ischaemic core, and propagate throughout the penumbra, at a rate similar to that of cortical spreading depression. 3. Cortical spreading depression in the normally perfused cortex does not result in histological damage whereas peri-infarct depolarisations augment neuronal damage in the penumbra, and are believed by many authors to constitute an important, or the principal, mechanism by which electrophysiological penumbra progressively deteriorates, ultimately undergoing terminal depolarisation and thus recruitment into an expanded core lesion. 4. There is some experimental evidence to suggest that under some circumstances induction of episodes of cortical spreading depression can confer protection against subsequent ischaemic insults. 5. Although cortical spreading depression and peri-infarct depolarisations have been extensively studied in the experimental in vivo models, there is now clear evidence that depolarisations also occur and propagate in the human brain in areas surrounding a focus of traumatic contusion. 6. Whether such events in the injured human brain represent cortical spreading depression or peri-infarct depolarisation is unclear. However, invasive and probably non-invasive monitoring methods are available which may serve to distinguish which event has occurred. 7. Much further work will be needed to examine the relationship of depolarisation events in the injured brain with outcome from cerebral ischaemia or head injury, to examine the factors which influence the frequency of depolarisation events, and to determine which depolarisation events in the human brain augment the injury and should be prevented.
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Affiliation(s)
- A J Strong
- Section of Neurosurgery, Department of Clinical Neurosciences, King's College, London, UK
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Faria LC, Mody I. Protective effect of ifenprodil against spreading depression in the mouse entorhinal cortex. J Neurophysiol 2004; 92:2610-4. [PMID: 15201313 DOI: 10.1152/jn.00466.2004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the brain, spreading depression (SD) is characterized by a large extracellular DC shift, a massive failure of ion homeostasis and a transient cessation of neuronal function. Clinically, SD is believed to be involved in various neurological disorders including migraine and cerebrovascular diseases. The propagation of cortical SD requires the release of glutamate, and N-methyl-D-aspartate (NMDA) receptors play a crucial role in this process. Here, we have isolated the NMDA receptor-mediated component of extracellularly recorded field excitatory postsynaptic potentials (fEPSPs) in layers 2-3 of the entorhinal cortex of murine brain slices. In the absence of GABAA and AMPA receptor-mediated synaptic transmission, stimulation of layer 6 afferents every 15-90 s elicited spontaneous SD on average within 18.5 min after the start of the stimulation. In the presence of ifenprodil, an NR2B receptor subunit-selective NMDA receptor antagonist, the occurrence of SD was nearly abolished. Our results are consistent with an important role of NR2B subunits in triggering SD in the entorhinal cortex.
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Affiliation(s)
- Leonardo Coutinho Faria
- Departamento de Neurologia e Neurocirurgia, UNIFESP-Escola Paulista de Medicina, São Paulo, SP 04023-900, Brazil
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Abstract
Optical imaging of activity-dependent pH changes using neutral red has revealed a novel form of propagated activity in the cerebellar cortex: spreading acidification and depression (SAD). Evoked by surface stimulation, SAD is characterized by a propagation geometry that reflects the parasagittal architecture of the cerebellum, high speed of propagation across several folia, and a transient depression of the molecular layer circuitry. The properties of SAD differentiate it from other forms of propagating activity in the nervous system including spreading depression and Ca++ waves. Involving several factors, SAD is hypothesized to be a regenerative process that requires a functioning parallel fibers-Purkinje cell circuit, glutamatergic neurotransmission, and is initiated by increased neuronal excitability. Three possible neuronal and glia substrates in the cerebellar cortex could account for the propagation geometry of SAD. Recently, the authors demonstrated that blocking voltage-gated Kv1.1 potassium channels plays a major role in the generation of SAD. This observation has lead to the hypothesis that the episodic and transient disruption in cerebellar function that characterizes episodic ataxia type 1, a Kv1.1 channelopathy, is due to SAD occurring in the cerebellar cortex.
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Affiliation(s)
- Timothy J Ebner
- Department of Neuroscience, University of Minnesota, Minneapolis 55455, USA.
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Guedes RCA, Amâncio-Dos-Santos A, Manhães-De-Castro R, Costa-Cruz RRG. Citalopram has an antagonistic action on cortical spreading depression in well-nourished and early-malnourished adult rats. Nutr Neurosci 2002; 5:115-23. [PMID: 12000081 DOI: 10.1080/10284150290018937] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Adult, well-nourished (W) and early-malnourished (M) male Wistar rats were injected intraperitoneally for 7 days with 20 mg/kg CIT and cortical spreading depression (CSD) was recorded for 4 h on the day following the treatment. M-animals presented lower body weights, as well as higher CSD velocities of propagation, than the W ones, as previously reported. Compared to saline-injected controls, rats treated with CIT for 7 days presented comparable body weights and lower mean CSD velocities, per hour of recording, the differences being significant at the second hour (3.29+/-0.31 versus 3.56+/-0.40 mm/min; P < 0.05). Topical, cortical application of CIT (1- and 5 mg/ml solutions over the intact dura-mater) reduced dose-dependently the CSD velocity (maximal reductions of 16.3 and 55.8% for the 1 and 5 mg/ml solutions, respectively; P < 0.05), as well as the amplitude of the CSD-slow potential change (58.2 and 88.3%). In three out of seven W-rats and in one out of seven M-rats, topical CIT (5 mg/ml) blocked CSD propagation. The effects were reverted by flushing the treated region with saline. In the M-groups, CIT affected CSD in the same manner as in the W ones. The results reinforce previous evidence for an antagonistic influence of the serotoninergic activity on CSD.
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Affiliation(s)
- R C A Guedes
- Departamento de Nutrição, Universidade Federal de Pernambuco, Recife, Brazil.
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