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Cortical spreading depression (CSD)

Ein neurophysiologisches Korrelat der Migräneaura

Cortical spreading depression (CSD)

A neurophysiological correlate of migraine aura

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Zusammenfassung

Die „cortical spreading depression“ (CSD) ist eine transiente (60–120 s) Depolarisation der Nerven- und Gliazellen der Hirnrinde (Verschiebung des kortikalen Gleichspannungspotenzials um 20–35 mV), die sich mit 3–5 mm/min über die Kortexhemisphäre ausbreitet. Während der CSD kommt es zu massiven Umverteilungen von Ionen zwischen dem Extra- und Intrazellulärraum sowie einem Wassereinstrom in die Zellen. Die extrazelluläre Kaliumionenkonzentration kann dabei bis auf 60 mM/l ansteigen. Kaliumionen und die exzitatorische Aminosäure Glutamat sind wesentlich an der Entstehung und Ausbreitung der CSD beteiligt. Sowohl die Depolarisation als auch die temporäre Störung der ionalen Homöostase sind regenerativ und verbrauchen bei der Restitution Energie, schädigen aber normal perfundiertes Hirngewebe nicht. Die gleiche Ausbreitungsgeschwindigkeit von CSD und Skotomen in der Migräneaura hat seit langem die Meinung gestützt, dass die CSD das Korrelat der Migräneaura sein soll. Seit der Beobachtung von CSD-ähnlichen Vorgängen bei Patienten während der Migräneaura im Magnetenzephalogramm (MEG) ist dieser Zusammenhang sehr wahrscheinlich geworden. Die Rolle der CSD als Verursacher des Migränekopfschmerzes ist dagegen umstritten.

Abstract

Cortical spreading depression (CSD) is a transient (60–120 s) and at 3–5 mm/min propagating depolarization wave of cortical neurons and glial cells and is characterized by a DC shift of 20–35 mV. It is accompanied by massive redistribution of ions between extracellular and intracellular compartments and by a water influx into the cells. Extracellular potassium ion concentration increases up to 60 mM/l. Potassium ions and the excitatory neurotransmitter glutamate essentially contribute to the initiation and propagation of CSD. Both depolarization and disturbance of brain ion homeostasis regenerate within a few minutes while enhancing energy metabolism, but do not cause damage to normally perfused brain tissue. The similar propagation velocity of CSD and visual scotoma during migraine aura led to the assumption that CSD could be the underlying mechanism of migraine aura. The observation of CSD waves in migraine aura patients with the magnet encephalogram (MEG) technique confirmed this theory. Although many data support the relationship between CSD and aura phase in migraine, the role of CSD in migraine headache is still disputed.

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  1. Institut für Physiologie I/Neurophysiologie, Friedrich-Schiller-Universität Jena, Teichgraben 8, 07740, Jena, Deutschland

    F. Richter

  2. Schmerztherapeutisches Zentrum - Tagesklinik, St.-Vinzenz-Krankenhaus Düsseldorf, Düsseldorf, Deutschland

    A. Lehmenkühler

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Correspondence to F. Richter.

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Richter, F., Lehmenkühler, A. Cortical spreading depression (CSD). Schmerz 22, 544–550 (2008). https://doi.org/10.1007/s00482-008-0653-9

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