Expert Seeks Improved Monitoring of ‘Brain Tsunamis’ after TBI

Dr. Jed Hartings, a former Major in the U.S. Army’s Medical Service Corps, has made the study of spreading depolarizations his life’s work. Photo by Cindy Starr.

Jed Hartings, PhD, Research Associate Professor at the UC Gardner Neuroscience Institute, is among the world’s leaders in the research of brain waves known as spreading depolarizations. These electrical disturbances spread like tsunamis through a brain injured by stroke or trauma. And like tsunamis, they cause destruction.

“Compared to normal brain waves, these really are tsunamis,” Dr. Hartings says. “They are 5 to 10 times the size of epileptic seizure discharges. Although they are very focal at any given time — with a spatial wavelength of just a centimeter of brain tissue — they spread widely through an injured lobe of the brain.”

Listen to a Brain Tsunami >>

Anyone who has suffered a migraine headache might have actually experienced a spreading depolarization.  “In an awake individual who is suffering a migraine, a single wave can cause blindness on one side or can cause your arm or face to go numb,” Dr. Hartings says. “Imagine what effect 20 to 50 of these waves will have in a comatose patient who has suffered a traumatic brain injury.”

Dr. Hartings, a founding member of the international organization COSBID (Co-Operative Study on Brain Injury Depolarizations), has devoted his career to understanding, monitoring and seeking an effective treatment for this pathologic brain activity.

“Our lab and our leadership have generated the evidence for the role of spreading depolarizations in traumatic brain injury worldwide,” Dr. Hartings says. “We really characterized this phenomenon and this disease.”

Dr. Hartings began by investigating spreading depolarizations as being possibly important. “Today,” he says, “we know they are important; we know they are relevant to patients’ outcomes; and we know that they occur in many patients.”

In 2011 Dr. Hartings was the lead author of two benchmark papers about spreading depolarizations, published in the prestigious journals Brain and Lancet Neurology. Dr. Hartings and his colleagues showed through their research that the depolarizations are not only linked to worse outcomes, they also cause worse outcomes. Stopping them with medical treatment, they reported, could prevent many victims of major head injury from suffering additional brain damage.

The research was funded largely by a four-year $1.96 million grant awarded through the U.S. Department of Defense’s Psychological Health and Traumatic Brain Injury (PH/TBI) Research Program (formerly known as the Post Traumatic Stress Disorder/TBI Research Program). The topic of spreading depolarizations has been of keen interest to the U.S. military since the emergence of head injuries as the signature wound of the wars in Iraq and Afghanistan.

Results of a more detailed study, also funded by the U.S. Department of Defense, are on the horizon. The five-year investigation involving 140 patients at five academic health centers will provide full clinical details about the occurrence of depolarizations and what sub-types of injury the depolarizations are associated with.

Even more dramatic findings are on the way. Although Dr. Hartings and his co-investigators currently monitor depolarizations by placing an electrode strip onto the brain of patients who undergo surgery, their newest research involves exploring different types of monitors that do not have to be placed directly on the brain. Such monitoring would benefit patients who have suffered brain injury but do not require surgery.

“One of our main objectives going forward is to develop techniques for measuring spreading depolarizations non-invasively, using a more traditional electroencephalograph, or EEG,” Dr. Hartings says. “Currently we can record them only from electrodes placed directly on the brain, which really limits us to studying maybe 5 or 10 percent of patients with traumatic brain injury. Ultimately, we need to translate that knowledge into a tool that can be used in a clinical, bedside device by any clinician.”

Dr. Hartings has published more than 40 peer-reviewed journal articles and has one patent and two invention disclosures to his credit.

— Cindy Starr

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