Intracortical impedance changes during spreading depression

Cortical spreading depression: an adverse but treatable factor in intensive care?

PURPOSE OF REVIEW

The aetiology and management of secondary deterioration in patients with acute traumatic or ischaemic brain injury remain serious challenges for clinicians and also for basic neuroscientists. The occurrence of spreading depolarization events and some of their features in the cerebral cortex in patients with traumatic brain injury and aneurysmal subarachnoid haemorrhage, as documented in recent papers, represent a novel pathophysiological mechanism in this setting.

RECENT FINDINGS

The history and definitions of two critically different patterns of depolarization are reviewed on the basis of their physiology and pathophysiology, particularly the responses of the cerebral microcirculation to depolarization as seen in the laboratory. It is now becoming possible to conduct similar assessments in the brain-injured patient. Currently the recorded incidence of depolarization events in patients undergoing craniotomy for traumatic contusions is in the region of 50-60%, rising to 72% following major subarachnoid haemorrhage.

SUMMARY

Realization of the therapeutic potential of the new findings will depend on clear knowledge of the impact of the different patterns of depolarization on outcome. Meantime, current results call for even stricter attention during clinical management of acute brain injury to secondary factors such as body temperature and plasma glucose.

Nuclear magnetic resonance (NMR) measurement of the apparent diffusion coefficient (ADC) of tissue water and its relationship to cell volume changes in pathological states

Diffusion-weighted nuclear magnetic resonance (NMR) imaging (DWI) is sensitive to the random translational motion of water molecules due to Brownian motion. Although the mechanism is still not completely understood, the cellular swelling that accompanies cell membrane depolarization results in a reduction in the net displacement of diffusing water molecules and thus a concomitant reduction in the apparent diffusion coefficient (ADC) of tissue water. Cerebral regions of reduced ADC appear hyperintense in a DWI and this technique has been used extensively to study acute stroke. In addition to cerebral ischemia, reductions in the ADC of cerebral water have been observed following cortical spreading depression, ischemic depolarizations (IDs), transient ischemic attack (TIA), status epilepticus, and hypoglycemia. Although the mechanism responsible for initiating membrane depolarization varies in each case, the ensuing cell volume changes follow a similar pattern. Water ADC values are also affected by the presence and orientation of barriers to translational motion (such as cell membranes and myelin fibers) and thus NMR measures of anisotropic diffusion are sensitive to more chronic pathological states where the integrity of these structures is modified by disease. Both theoretical prediction and experimental evidence suggest that the ADC of tissue water is related to the volume fraction of the interstitial space via the electrical conductivity of the tissue. The implication is that acute neurological disorders that exhibit electrical conductivity changes should also exhibit ADC changes that are detectable by DWI. A qualitative correlation between electrical conductivity and the ADC of water has been demonstrated in a number of animal model studies and the results indicate that reduced ADC values are associated with reductions in the extracellular volume fraction and increased extracellular tortuosity. The close relationship between ADC changes and cell volume changes in various pathological states suggests that NMR measurements are also sensitive to chemical communication between cells through the extracellular space (i.e., extrasynaptic or volume transmission, VT).

Mechanisms of spreading depression and hypoxic spreading depression-like depolarization

Spreading depression (SD) and the related hypoxic SD-like depolarization (HSD) are characterized by rapid and nearly complete depolarization of a sizable population of brain cells with massive redistribution of ions between intracellular and extracellular compartments, that evolves as a regenerative, "all-or-none" type process, and propagates slowly as a wave in brain tissue. This article reviews the characteristics of SD and HSD and the main hypotheses that have been proposed to explain them. Both SD and HSD are composites of concurrent processes. Antagonists of N-methyl-D-aspartate (NMDA) channels or voltage-gated Na(+) or certain types of Ca(2+) channels can postpone or mitigate SD or HSD, but it takes a combination of drugs blocking all known major inward currents to effectively prevent HSD. Recent computer simulation confirmed that SD can be produced by positive feedback achieved by increase of extracellular K(+) concentration that activates persistent inward currents which then activate K(+) channels and release more K(+). Any slowly inactivating voltage and/or K(+)-dependent inward current could generate SD-like depolarization, but ordinarily, it is brought about by the cooperative action of the persistent Na(+) current I(Na,P) plus NMDA receptor-controlled current. SD is ignited when the sum of persistent inward currents exceeds persistent outward currents so that total membrane current turns inward. The degree of depolarization is not determined by the number of channels available, but by the feedback that governs the SD process. Short bouts of SD and HSD are well tolerated, but prolonged depolarization results in lasting loss of neuron function. Irreversible damage can, however, be avoided if Ca(2+) influx into neurons is prevented.

Use of intrinsic optical signals to monitor physiological changes in brain tissue slices

Optical imaging techniques have the potential to bring a combination of high spatial and temporal resolution to studies of brain function. Many optical techniques require the addition of a dye or fluorescent marker to the tissue, and such methods have proven extremely valuable. It is also known that the intrinsic optical properties of neural tissue are affected by certain physiological changes and that these intrinsic optical signals can provide information not available by other means. Most authors attribute the intrinsic optical change to alterations in cell volume and concomitant change in the concentration of the cytosol. In this article we review the literature on intrinsic optical signals, covering both the mechanisms of the optical change and its use in various branches of neurophysiology. We also discuss technical aspects of the technique as used with hippocampal slices, including illumination methods, cameras, experimental methods, and data collection and analysis procedures. Finally we present data from investigations in which we used intrinsic optical signals in hippocampal slices to study the extent of spread of synaptic activation, propagation of spreading depression, extent and severity of the response to hypoxia, and tissue response to osmotic challenges. We conclude that (1) at least two processes generate intrinsic optical signals in hippocampal slices, one of which causes light scattering to change inversely with cell volume and is related to dilution of the cytoplasm, while the other, opposite in sign, may be due to mitochondrial swelling; and (2) the intrinsic optical signal can be a useful tool for spatial mapping of relatively slow events, but is not suitable for study of fast physiological processes.

Signals and signs in the nervous system: the dynamic anatomy of electrical activity is probably information-rich

The dichotomy between two groups of workers on neuroelectrical activity is retarding progress. To study the interrelations between neuronal unit spike activity and compound field potentials of cell populations is both unfashionable and technically challenging. Neither of the mutual disparagements is justified: that spikes are to higher functions as the alphabet is to Shakespeare and that slow field potentials are irrelevant epiphenomena. Spikes are not the basis of the neural code but of multiple codes that coexist with nonspike codes. Field potentials are mainly information-rich signs of underlying processes, but sometimes they are also signals for neighboring cells, that is, they exert influence. This paper concerns opportunities for new research with many channels of wide-band (spike and slow wave) recording. A wealth of structure in time and three-dimensional space is different at each scale-micro-, meso-, and macroactivity. The depth of our ignorance is emphasized to underline the opportunities for uncovering new principles. We cannot currently estimate the relative importance of spikes and synaptic communication vs. extrasynaptic graded signals. In spite of a preponderance of literature on the former, we must consider the latter as probably important. We are in a primitive stage of looking at the time series of wide-band voltages in the compound, local field, potentials and of choosing descriptors that discriminate appropriately among brain loci, states (functions), stages (ontogeny, senescence), and taxa (evolution). This is not surprising, since the brains in higher species are surely the most complex systems known. They must be the greatest reservoir of new discoveries in nature. The complexity should not deter us, but a dose of humility can stimulate the flow of imaginative juices.

Design considerations and performance of a prototype system for imaging neuronal depolarization in the brain using 'direct current' electrical resistance tomography

The ability to image the impedance changes that accompany neuronal depolarization in the brain would constitute a major advance in neuroscience technology. Unfortunately, these changes are likely to be small and rapid and so difficult to measure. The impedance change at frequencies above 10 kHz, as used by conventional EIT systems, may be estimated to be about 0.1%. Modelling indicates that a much larger impedance change of about 7% may occur with DC or very-low-frequency excitation. Difficulties with this approach include a low permissive current level and high electrode impedance. We constructed a prototype system employing square wave excitation at 5 Hz to evaluate such problems. It was tested in a saline-filled tank, recording 4000 frames s-1 at a current level of 50 microA. After averaging 100 sets of frames, the signal to noise ratio was 40-50 dB, and reciprocity errors were mostly 10-20%. Images of discrete resistivity changes of less than 10% could be obtained, but with significant systematic errors. While our prototype would not be suitable for neurophysiological imaging as it stands, it has enabled us to determine the modifications that would be required to construct a system for this application.

Spreading waves of decreased diffusion coefficient after cortical stimulation in the rat brain

A method is demonstrated for the noninvasive detection and study of spreading cortical depression. Spreading depression (SD) was elicited in rats by topical application of potassium chloride to the exposed cortex. The apparent diffusion coefficient (Dapp) of water in a region of the cortex, measured using a PFG-NMR spin echo sequence with an observation time of 40 ms, declines 35% within 30 s and recovers to the normal value within the next 30 s. The region of decreased Dapp was shown to be 2 mm in size and to move in the cortex, away from the point of application, with a uniform velocity of 3.3 +/- 0.5 mm/min. The behavior of the affected region is consistent with other reports of the behavior of SD as monitored by electrophysiological means. The technique can be implemented on currently available MRI equipment and makes possible the noninvasive study of SD in animal models of neurological disorders, their therapeutic intervention, and possibly the study of SD in humans.

Imaging of cortical spreading depression by EIT: implications for localization of epileptic foci

Severe epileptics may require curative neurosurgery. Sometimes focus localization requires recording with electrodes inserted deep into the brain, which may cause death or permanent neurological damage. Since epileptic seizures are associated with marked changes in cerebral impedance, we propose that EIT with sub-dural electrodes (inserted between the brain and skull) could provide a superior and less dangerous method for the localization of epileptic foci. The purpose of these experiments was to determine whether EIT could be used to localize the origin of seizure activity. In terms of impedance characteristics, an appropriate model is cortical spreading depression in the animal brain. Six rabbits were anaesthetized and paralysed and the brain exposed. EIT images and DC potentials were recorded from an array of 16 electrodes on the brain during cortical spreading depression induced by DC stimulus. Cortical spreading depression could be localized by EIT with an accuracy of 8.7% +/- 6.4% (mean +/- SD) of electrode array diameter. The errors in localization appeared to be distributed randomly. In a phantom of similar geometry, the error was 5% after correction for a systematic component. Results are sufficiently encouraging that we intend to extend this study to human patients.

Comparison of ongoing compound field potentials in the brains of invertebrates and vertebrates

(1) Ongoing compound field potential fluctuations of higher brain centers (the micro-EEG of some authors) are considered as a biological phenomenon, a sign of the activity in the organized assemblage of cells. Such activity has been compared in several taxa with quite different brain structure to look for possible evolution in the form of the field potentials and for possible explanations of differences and similarities. (2) Recordings were made with semimicroelectrodes in the neuropile of the cerebral ganglion of the mollusc, Aplysia, with comparative observations on Helix, and the arthropods Limulus, Melanoplus, and Cambarus, and in or on the cerebral cortex and optic tectum of rays, cats and rabbits, with comparative observations on sharks, bony fish, turtles and geckos in unstimulated resting or generalized arousal states. Manipulations of state did not alter the main findings. (3) Power spectra in the cerebral ganglia of various higher invertebrates are similar; activity is fast and spikey (with the exception of Octopus). Integrated energy above 50 Hz exceeds that from 2-50 Hz and falls slowly with frequency; in Aplysia the power spectrum falls less than 10 dB between 10 and 300 Hz. In vertebrates from fish to mammals activity is similar in being mainly slow (less than 40 Hz); it commonly falls greater than 20 dB between 10 and 50 Hz. (4) Amplitude is low in invertebrates and lower vertebrates. RMS voltage in Aplysia (3-300 Hz, reference electrode remote) is typically less than 10 microV; in the ray optic tectum less than 25 microV (2-50 Hz); in the dorsal cortex of the gecko less than 30 microV, in the cat cortex greater than 85 microV. In the vertebrates amplitude does not change greatly with small shifts in electrode position, as it does in invertebrates. (5) Coherence decline with distance, measured tangentially at different electrode separations in the millimeter range, is used as an estimator of synchrony. Averaged coherence between loci 1 mm apart is negligible in Aplysia in any band from 3 to 100 Hz; in the ray tectum it is low, 0.25-0.5 between 3 and 16 Hz. In the turtle dorsal pallium it is higher, at 2 mm, 0.6-0.75 in this band. In the rabbit cortex coherence is even higher, typically greater than 0.7 at 1 mm, and greater than 0.3 at 4 mm in this band. (6) Band-pass filtered electrograms, ca. one octave wide, in all species show constant waxing and waning in each band; amplitude is not maintained even for a second. (ABSTRACT TRUNCATED AT 400 WORDS)

Electrical impedance of isolated retina and its changes during spreading depression

The electrical impedance of isolated chick and toad retinas were measured in the absence of, and during, spreading depression, using sinusoidal measuring currents ranging from 10 to 50,000 Hz. Data obtained in the absence of the reaction indicate an electric heterogeneity of the tissue and suggest that at least two groups of cells are responsible for the observed frequency distribution. Spreading depression is accompanied by impedance changes that depend on the frequency of the measuring current and composition of the Ringer's solution. In chick retinas immersed in standard solution, impedance magnitude (Z) as well as phase angle (0) change in phase, displaying an initial increase followed by a longer decrease; in the toad, these changes depend on the measuring frequency: at 10 Hz they are similar to the ones observed in chick retinas, whereas at intermediate and high frequencies they are out of phase. In low Cl- + sucrose Ringer's solution a decrease of impedance is observed in both chick and toad retinas. In low Cl- + Na2SO4 + sucrose Ringer's solution a decrease of impedance also predominates but the Z and 0 curves are biphasic and complex, having time courses which are frequency-dependent. In addition, these changes are different in chick and toad preparations. The experiments show that the impedance changes during the retinal reaction might be related both to extracellular as well as cellular currents. The extracellular current changes could be due to decrease of ionic content and volume of extracellular space, the latter variations being drastically reduced when retinas are immersed in low Cl- solutions. The results also suggest changes of current flow through cellular components which are frequency-dependent: at low frequencies the preferential path being probably through neuronal, and at high frequencies, through glial cells.

Cortical impedance and extracellular volume changes following middle cerebral artery occlusion in cats

In 30 adult cats, anesthetized with nitrous oxide and halothane, the middle cerebral artery was occluded using a transorbital approach. Extracellular volume changes were assessed by recording cortical impedance, and correlated with blood flow, tissue osmolality, and water and electrolyte content of brain tissue. Following middle cerebral artery occlusion, cortical impedance, after a free interval of about 1 min, sharply increased and after 30 to 60 min gradually stabilized between 180 and 200% of control. Calculated extracellular fluid volume decreased from 23.8 +/- 1.2 to 1.3 +/- 1.0% after 1 h and to 12.5 +/- 1.0% after 2 h of ischemia. Shortly after middle cerebral artery occlusion, extracellular volume shifts correlated with blood flow over a range from 3 to 50 ml/100 g/min. Two hours later, a threshold-like dependency existed: below 25 ml/100 g/min extracellular space was reduced to about 50% of control; above 32 ml/100 g/min extracellular space was normal. Non-threshold correlations existed between extracellular space, tissue osmolality, and the electroencephalogram. Final water content of brain tissue correlated with the size of the extracellular space after 15 min, but ont after 2 h of ischemia. This indicates that the narrowing of the extracellular compartment and ischemic brain edema are relatively independent consequences of cerebral ischemia.

Techniques and applications of extracellular space determination in mammalian tissues

This review summarizes the ways in which the extracellular space (ECS) may be estimated in mammalian tissues, and briefly describes some of the uses to which the EC confinement of certain molecules (markers or tracers) may be put in the elucidation of physiological functions. The introductory section is followed by a description of the more commonly used marker molecules and their functional characteristics, and of factors likely to lead to the spurious over- or under-estimation of the ECS. Certain alternative methods are also described, in particular those based on morphological and electrical criteria which seek to demonstrate small, functionally important, changes in the size of specialized regions of the ECS (e.g. lateral cellular interspaces) without necessarily being required to provide a quantitatively precise estimate of their size. Section III describes the results of measurements of ECS in various mammalian tissues (muscle, gastro-intestinal tract, nervous tissue, crystalline lens, placenta, lung and kidney) and some applications of EC markers to investigation of cellular function (e.g. uptake of metabolic substrates and epithelial transport) and, in outline, characterization of capillary permeability. The available literature in this field is very extensive, and in the interests of brevity the reader is, where appropriate, referred to previous reviews covering specialized aspects of ECS determination and related topics.

Brain extracellular space during spreading depression and ischemia

The change of extracellular space volume of rat brain cortex during ischemia and cortical spreading depression, CSD (Leão 1944) was evaluated by a new method. The cortical surface was irrigated with isotonic CSF containing the extracellular markers 50 mM cholin or 50 mM trimethyltris(hydroxymethyl)methyl ammonium ion (N-TRIS), and their extracellular concentrations were monitored by ion-selective microelectrodes. When steady-state for the concentration of these markers was attained, CSD evoked a reversible increase of the concentration of the markers, indicating shrinkage of the interstitial volume of distribution. During ischemia an initial slow rate of concentration increase was observed, followed a few minutes later by a rapid increase concomitant with the sharp rise in extracellular potassium concentration. During CSD and ischemia, the maximal increases of choline and N-TRIS concentration reflected a shrinkage of the extracellular space amounting to about 50% of the initial volume.