Editors' ChoiceNeuroscience

A Cool Intervention for Posttraumatic Epilepsy

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Science Translational Medicine  24 Apr 2013:
Vol. 5, Issue 182, pp. 182ec69
DOI: 10.1126/scitranslmed.3006347

Up to 75% of people who survive traumatic brain injury develop epileptic seizures that manifest days to years after the traumatic event. These seizures, which are notoriously difficult to manage, cannot be prevented by current interventions. It is well established that short-term cooling of the brain can prevent or limit brain damage caused by other harmful events such as cardiac arrest and cardiovascular surgery. Whether brain cooling can effectively prevent posttraumatic epilepsy has been relatively unexplored. Now, D’Ambrosio and colleagues report that 5 to 6 weeks of continuous, focal brain cooling, by as little as 0.5 to 2⁰C, virtually stops the development of epileptic seizures in a common rat model of posttraumatic epilepsy. The investigators created a small trauma to the cortical surface of the brain in anesthetized rats and 3 days later began to cool the surface of the brain immediately surrounding the traumatic lesion. This intervention resulted in up to 99% reduction in seizure frequency, with the effect persisting for at least 10 weeks after cessation of cooling. A limited assessment of markers for brain tissue injury and electrical activity did not reveal evidence of brain damage or compromised electrical activity due to the cooling. This study demonstrates that chronic, low-grade brain cooling can be used to effectively prevent posttraumatic epilepsy in rats. The significance of this study is that low-grade, targeted cooling of the brain appears to be a relatively simple, safe, and a highly effective intervention in a well-established animal model of posttraumatic epilepsy. Now, further studies are needed to assess the feasibility and efficacy of this approach in humans with traumatic brain injury.

R. D’Ambrosio et al., Mild passive focal cooling prevents epileptic seizures after head injury in rats. Ann. Neurol. 73, 199–209 (2013). [Full text]

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