Differential temperature sensitivity of synaptic and firing processes in a neural mass model of epileptic discharges explains heterogeneous response of experimental epilepsy to focal brain cooling

Focal Cooling for Drug-Resistant Epilepsy: A Review

Importance

Epilepsy affects at least 1.2% of the population, with one-third of cases considered to be drug-resistant epilepsy (DRE). For these cases, focal cooling therapy may be a potential avenue for treatment, offering hope to people with DRE for freedom from seizure. The therapy leverages neuroscience and engineering principles to deliver a reversible treatment unhindered by pharmacology.

Observations

Analogous to (but safer than) the use of global cooling in postcardiac arrest and neonatal ischemic injury, extensive research supports the premise that focal cooling as a long-term treatment for epilepsy could be effective. The potential advantages of focal cooling are trifold: stopping epileptiform discharges, seizures, and status epilepticus safely across species (including humans).

Conclusions and Relevance

This Review presents the most current evidence supporting focal cooling in epilepsy. Cooling has been demonstrated as a potentially safe and effective treatment modality for DRE, although it is not yet ready for use in humans outside of randomized clinical trials. The Review will also offer a brief overview of the technical challenges related to focal cooling in humans, including the optimal device design and cooling parameters.

Feasibility of focal brain cooling for partial epilepsy with secondary generalization: A computational study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020;2020:2532-2535. [PMID: 33018522 DOI: 10.1109/embc44109.2020.9175157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Experiments with animal models of epilepsy have consistently shown that focal cooling of epilepsy-induced brain region reversibly suppresses or terminates epileptic discharge activity. Recently, we formulated a physiologically plausible temperature dependence in a neural mass model that can reproduce the effect of focal cooling on epileptic discharge activity. This can be used to implement a temperature control in an implantable cooling device for thermal neuromodulation of the epileptogenic zone in patients with partial epilepsy when seizure activity is detected. However, there have been no experiments that looked into the effect of focal cooling in animal models of epilepsy with secondary generalization in which the seizure activity spreads from the pathologic region to other regions of the brain. Using the temperature-dependent neural mass model and a physiological coupling model, we show that focal cooling stops the propagation of low-frequency discharge activity; on the other hand, it increases the amount of coupling required to propagate high-frequency discharge activity. Moreover, discharge activities that are propagated with cooling are lower in both magnitude and frequency compared to those propagated without cooling. These results suggest the feasibility of focal cooling as an effective alternative therapeutic treatment for medically intractable partial epilepsy even with secondary generalization.Clinical Relevance- The computational study establishes focal cooling of the brain region with partial epilepsy not only suppresses epileptic discharges but can also prevent its generalization to other brain regions.