By the iCSD2018 Scientific Committee
The first annual meeting of the Neurocritical Care Society was held in Phoenix, Arizona, in February 2003. In November of the same year, a small group of neurologists and neurosurgeons gathered in Copenhagen, Denmark, for the first annual meeting of what would be known as the Co-Operative Studies on Brain Injury Depolarizations (COSBID). After 15 years of cultivating their missions and expanding their reach, NCS and COSBID will come together this September for affiliated annual meetings in Boca Raton, Florida.
Following the seminal discovery of Leão’s spreading depression in the human brain, COSBID was founded as a clinical collaboration to investigate the relevance of these events—known today as spreading depolarizations (SDs)—to human neurologic disease. Those early years were captured in the pages of this newsletter in June 2006 (M. Koenig). Now, over 10 years later, COSBID investigators have developed a substantial literature that has firmly established the prevalence and importance of SDs to patients with critical brain injury—and thus to neurocritical care.
Since the initial meeting in 2003, the COSBID ethos has been open collaboration and outreach to scientific communities, both basic and clinical. In 2017, the annual meeting was re-formulated as the International Conference on Spreading Depolarizations (iCSD) to cultivate an open community and highlight SD as its own field of translational neuroscience. Last year’s iCSD was held as a satellite of Brain, the biannual meeting of the International Society for Cerebral Blood Flow and Metabolism, in Berlin, Germany, and attracted 120 attendees from 19 countries.
This cooperative spirit will continue in 2018. As an official satellite of the NCS Annual Meeting, iCSD will take place at the Boca Raton Resort and Club in Boca Raton, Florida, on Sept. 22-24, immediately preceding NCS on Sept. 25-28. The iCSD program will begin with a short session and welcome reception on Sept. 22, followed by two full days of program content. A special off-site dinner, always a highlight of these meetings, will be held Sunday evening.
iCSD meeting information can be found at www.cosbid.org/icsd, and all are welcome to attend. While SD is the common thread of the program, it weaves together a wide variety of topics including cerebral metabolism, blood flow, neurovascular coupling, seizures, excitotoxicity, blood-brain barrier and edema. Moreover, the clinical and basic sciences are equally represented. With presentations running the gamut from clinical outcomes to electron microscopy, the depth of field in bench-to-bedside translation is truly unparalleled.
Many decades of experimentation have shown that SDs are the principal mechanism of acute lesion development in cerebral gray matter. They are monitored in patients by placing electrode strips on the brain after craniotomy for decompression, lesion evacuation or aneurysm repair. Presently, this technique has been used to monitor over 800 patients at 17 different medical centers in eight countries. The incidence of SD findings ranges from 50 percent to nearly 100 percent in patients with brain trauma or various types of stroke.
In this bedside monitoring, SDs recur as a secondary injury process for days to weeks after the initial ictus. They have been associated with early brain injury and delayed cerebral ischemia after subarachnoid hemorrhage, and worse outcome after trauma. Importantly, SDs affect not only the neurons, but can also cause profound microvascular constriction (aka spreading ischemia) that worsens hypoxic-ischemic conditions. In a vicious cycle, this promotes the further occurrence of SDs and lesion development.
The presence of iCSD as a satellite also brings the opportunity for new content at the NCS Annual Meeting, which will feature a symposium on “Spreading Depolarizations: the Silent Culprit of Secondary Injury That You’ve Been Missing.” The symposium will provide an overview of the application of SD monitoring in the clinic, with topics including delayed cerebral ischemia, use in multimodal monitoring and treatments.
Those looking for a deeper dive can also attend a new workshop on Sept. 25 on “Clinical Monitoring of Spreading Depolarizations.” This workshop is intended to meet the demand for education as new investigators become interested in the field. It will address common questions such as: How are SDs different from spreading depression? Can we record SD with our hospital’s EEG systems? Can you diagnose SDs in scalp recordings? The curriculum will include practical exercises with real data and is targeted to a general audience.
On behalf of the iCSD community, we thank the Neurocritical Care Society for their warm welcome and invite members to consider attending and submitting their work to iCSD. We look forward to an intense week of vibrant discussion, and the new collaborations and friendships to follow. See you in Boca!The iCSD2018 Scientific Committee
Jed Hartings, PhD
Brandon Foreman, MD
Raimund Helbok, MD
Bill Shuttleworth, PhD
Cenk Ayata, MD, PhD
Jens Dreier, MD, PhD#NCSRoundup #International