Brain Cooling May Prevent Trauma-Induced Epilepsy

A new study suggests that gently cooling the brain after injury may prevent difficult to control post-traumatic epilepsy (PTE).

Researchers at Washington University School of Medicine (St. Louis, MO, USA) examined the effect of mild passive focal cooling of the neocortex on the development of PTE after induced fluid percussion injury in rats, which reliably induces a perilesional epileptic focus within weeks of injury. Focal cooling was induced with ECoG headsets engineered for calibrated passive heat dissipation. Epileptic seizures were assessed by video-electrocorticography (ECoG) 2-16 weeks post-injury,and tissue pathophysiology was assessed by glial fibrillary immune-staining, cortical sclerosis, gene expression of inflammatory cytokines interleukin (IL)-1α and IL-1β, and ECoG spectral analysis.

The results showed that mild passive cooling by 2 °C for 5.5 weeks, beginning three days after injury, virtually abolished epileptic activity. The treatment caused no additional pathology or inflammation, and normalized the power spectrum of stage N2 sleep. Conversely, control rats that wore inactive headset had progressively longer and more severe seizures weeks after the injury, but the rats whose brains had been cooled by the ECoG headsets only experienced a few very brief seizures, as long as four months after injury. The study was published in the February 2013 issue of Annals of Neurology.

“Traumatic head injury is the leading cause of acquired epilepsy in young adults, and in many cases the seizures can’t be controlled with medication,” said senior author associate professor of neurological surgery and of pediatrics Matthew Smyth, MD. “These findings demonstrate potent and persistent prevention and modification of epileptic seizures after head injury with a cooling protocol that is neuroprotective, compatible with the care of head injury patients, and conveniently implemented.”

PTE is prevalent, often difficult to manage, and currently cannot be prevented; it is not known how to predict who will develop epilepsy after TBI and who will not, but it is known that the likelihood of developing PTE is influenced by the severity and type of injury; for example penetrating injuries and those that involve bleeding within the brain confer a higher risk. The onset of PTE can occur within a short time of the physical trauma that causes it, or months or years after. PTE may be caused by several biochemical processes that occur in the brain after trauma, including overexcitation of brain cells and damage to brain tissues by free radicals.

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