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"Brain tsunamis" are clue to helping victims of major head injuries

Treating “brain tsunamis” or “killer waves” could stop many victims of major head injury from suffering additional brain damage, a study published in Lancet Neurology has found. 

For decades, scientists have investigated this phenomenon. The Lancet Neurology study, led by Professor Anthony Strong at the Institute of Psychiatry at King’s College London, supports the original clinical evidence that brain tsunamis are common in patients with major brain injuries, and now shows – for the first time – that they contribute to worse outcomes in these patients. Longer-term, it is hoped the results of this study will be used to help guide how brain injuries are treated and managed, leading to better outcomes for patients. 

When a brain injury occurs, nerve cells in the brain (which act like batteries by storing electrical and chemical energy) malfunction and effectively short-circuit. Because all nerve cells in the brain are connected, this depolarization causes all the neighboring cells to short-circuit as well; this subsequent leakage of precious electrical charge moves like a tsunami through the brain, with the potential to cause additional permanent tissue damage.  

Researchers from the Institute of Psychiatry at King’s College London worked with King’s College Hospital and King’s College London (both part of King’s Health Partners Academic Health Sciences Centre) in collaboration with the department of neurosurgery at the University of Cincinnati (UC) College of Medicine and the UC Neuroscience Institute. 

Anthony Strong, Emeritus Professor of Neurosurgery at the Department of Clinical Neuroscience in the Institute of Psychiatry, at King’s College London and a former neurosurgeon at King’s College Hospital says the results were promising: 

‘This is an exciting area of research, which is attracting a lot of interest and collaboration internationally. This study provides real, concrete evidence that brain tsunamis can cause further damage to the brain in the few days after a major injury. This is significant, because they have a direct link to poor recovery in patients. Of course, the end goal is to take the results of this study and, longer term, develop new treatments for this type of injury. This potentially may mean finding a way of blocking these killer waves as they are happening.'

The study found that of 103 patients undergoing neurosurgery following major head trauma, 58 experienced a phenomenon called cortical spreading depolarizations, or “brain tsunamis.” 

To measure the depolarizations, researchers placed a linear strip of electrodes on the surface of the brain, near the injured area, during neurosurgery. Only patients who required brain surgery to treat their injuries were enrolled in the study. King’s College Hospital is a Major Trauma Centre for London, and regularly treats patients who are suitable candidates for the trial. 

The study was funded largely by a four-year $1.96 million grant awarded through the 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 is of keen interest to the U.S. military because head injuries have emerged as the signature wound of the wars in Iraq and Afghanistan.

For full paper: Hartings, J.A. et al. ‘Spreading depolarizations and outcome after traumatic brain injury: a prospective, observational study’ Lancet Neurology (December 2011) doi:10.1016/S1474-4422(11)70243-5 

For more information, please contact Seil Collins, Press Officer at the Institute of Psychiatry, King’s College London, email: or tel: 0207 848 5377
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