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Battling the effects of cerebral tsunamis

Copyright © 2019 Albuquerque Journal

C. Cunningham/Albuquerque Journal

New brain discoveries from research at the University of New Mexico School of Medicine and other collaborating facilities around the world are creating protocols and treatments to reduce the damage from stroke and other brain injuries.

Stroke is a killer. It is responsible for one in five deaths in the United States, according to the American Stroke Association. And those who survive may have severe disabilities.

Neuroscientist Bill Shuttleworth, Ph.D, says that’s because the clot (ischemic stroke about 85 percent of cases) or the burst artery (hemorrhagic stroke, the rest) is only the beginning of what the brain experiences.

Aftershocks or giant waves wash over the brain, stopping it from processing and communicating at a cellular level, creating even more damage.

“It’s a brain tsunami,” explains Shuttleworth, Regents Professor, Department of Neurosciences UNM School of Medicine and director of the Center for Brain Recovery and Repair.

It’s as if the stroke or traumatic brain injury is an earthquake that triggers the tsunami’s tidal waves.

“Something precipitates it. A major earthquake off the coast of Portugal can cause the southern shores of England to flood.”

Neurosurgeon Andrew Carlson says even those who get treatment in the first critical hours after a stroke to restore blood flow in the brain may still experience the effects of brain tsunamis or spreading depolarization.

And 60 to 80 percent of those with severe traumatic head injuries experience these damaging episodes when the brain stops sending signals, he and his colleagues wrote in a recent paper on the topic in the Journal of Neurosurgery, May 2018.

The research article reported on a pilot trial of drugs, designed to suppress the progressive damage.

“The field of treatment for stroke has a long and depressing history. The medication that works in the first few days may be harmful later,” says Carlson, who adds that greater understanding of spreading depolarization in the brain will bring new treatments and greater recovery.

“Tsunamis are bigger than seizures, but you can’t see them. They are bigger events and relatively common,” Shuttleworth says.

Studying these events has been almost impossible because it requires direct monitoring of the brain under the skull, only possible if part of the skull has been removed.

The pilot trial in the research paper followed 10 people, who had such injuries to the brain requiring surgery, so their doctors and caregivers could know from electrical activity when these blackouts were rolling through the brain and see if medical treatment helped prevent them.

Shuttleworth explains that most brain imaging and monitoring studies pick up the rapid fire of brain activity, but the slow waves of inactivity have been hard to detect.

Researchers have also discovered that a less damaging version of this phenomenon occurs in people who have migraines and may occur in a variety of other conditions, he says.

“It has a huge impact beyond brain injury and stroke,” Carlson adds.

The tight knit group of researchers and clinicians at UNM is making global strides. “Faculty and students here are hitting it out of the park,” says Shuttleworth, who is on the steering committee of Co-Operative Studies on Brain Injury Depolarizations, COSBID, an international collaborative research group.

“This has been the biggest change in thinking in how brain injury works,” Shuttleworth says. “We’re taking the results of our research right back to the clinic. Science is informing treatment. We are testing interventions of drugs that might make patients better.”

Shuttleworth will speak on Brain Tsunamis and other related disorders April 24, at the New Mexico Natural History Museum in connection with the exhibit, Brain: The Inside Story.

 

 

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