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Cortical spreading depolarization and ketamine: a short systematic review
João Paulo Mota Telles1, Leonardo Christiaan Welling2, Antonio Carlos Samaia da Silva Coelho1
1Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), Brazil.
Neurophysiologie Clinique = Clinical Neurophysiology
|February 21, 2021
Summary
Ketamine effectively blocks cortical spreading depolarization (SD), a pathological brain wave, in preclinical and human studies. Further trials are needed to confirm clinical benefits and safety for conditions like traumatic brain injury.
Area of Science:
- Neuroscience
- Pharmacology
Background:
- Cortical spreading depolarization (SD) involves sustained neuronal and astrocyte depolarization spreading across the cortex.
- SD is implicated in various neurological conditions, necessitating therapeutic interventions.
Purpose of the Study:
- To conduct a qualitative review of existing evidence on ketamine's efficacy in blocking SD.
- To synthesize preclinical and clinical findings regarding ketamine's role in managing SD.
Main Methods:
- A systematic review of Medline was performed without date or language restrictions.
- Search terms included "ketamine," "spreading," "depolarization," and "depression" in various combinations.
Main Results:
- Twenty studies were synthesized, demonstrating ketamine's effectiveness in blocking SD across species (rats, swine, humans).
- A 2018 prospective randomized trial showed ketamine's dose-dependent reduction of SD in patients with severe traumatic brain injury or subarachnoid hemorrhage.
Conclusions:
- Preclinical evidence supports ketamine's potential in clinical applications for migraine with aura, TBI, SAH, and stroke.
- Further randomized controlled trials are essential to validate outcome improvements and assess adverse effects of ketamine-induced SD interruption.
