Design of focal brain cooling system for suppressing epileptic seizures

Hata, Kei; Fujiwara, Koichi; Kano, Manabu; Inoue, Takao; Nomura, Sadahiro; Imoto, Hirochika; Suzuki, Michiyasu

doi:10.1109/embc.2017.8036817

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…It is well known that hypothermia around 32-34°C helps protect the brain in patients experiencing postcardiac arrest 12 or severe neurotrauma [13][14][15][16] through the suppression of brain metabolism 17 and glutamate release. 18 We found that epileptic seizures terminated at 15°C or lower [19][20][21][22][23][24][25][26][27][28] and found that neuronal function deteriorated at 10°C or lower. 29,30 The threshold of low temperature for histological brain damage is not known exactly; however, irreversible damage occurred neither by continuous cooling at 5°C for 1 hour 31 nor by cooling in repeats of 30 sec at 5°C with a 1.5-min interval for 2 hours.…”

mentioning

confidence: 85%

A focal brain-cooling device as an alternative to electrical stimulation for language mapping during awake craniotomy: patient series

Nomura¹,

Inoue

Imoto³

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Functional mapping in awake craniotomy has the potential risk of electrical stimulation-related seizure. The authors have developed a novel mapping technique using a brain-cooling device. The cooling probe is cylindrical in shape with a thermoelectric cooling plate (10 × 10 mm) at the bottom. A proportional integration and differentiation-controlled system adjusts the temperature accurately (Japan patent no. P5688666). The authors used it in two patients with glioblastoma. Broca’s area was identified by electrical stimulation, and then the cooling probe set at 5°C was attempted on it. OBSERVATIONS Electrocorticogram was suppressed, and the temperature dropped to 8°C in 50 sec. A positive aphasic reaction was reproduced on Broca’s area at a latency of 7 sec. A negative reaction appeared on the adjacent cortices despite the temperature decrease. The sensitivity and specificity were 60% and 100%, respectively. No seizures or other adverse events related to the cooling were recognized, and no histological damage to the cooled cortex was observed. LESSONS The cooling probe suppressed topographical brain function selectively and reversibly. Awake functional mapping based on thermal neuromodulation technology could substitute or compensate for the conventional electrical mapping.

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confidence: 85%

A focal brain-cooling device as an alternative to electrical stimulation for language mapping during awake craniotomy: patient series

Nomura¹,

Inoue

Imoto³

et al. 2021

Journal of Neurosurgery: Case Lessons

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“…The Peltier cooling system has been extensively studied for the treatment of epilepsy and has demonstrated clinical efficacy with an intraoperative application in epilepsy patients (Nomura et al, 2014). Efforts to develop clinically feasible implantable device are continuing (Dinis et al, 2017;Hata et al, 2017), and Peltier's elementbased cooling has been successfully tested in nonhuman primate (Inoue et al, 2017), as a potential clinically therapeutic strategy.…”

Section: Discussionmentioning

confidence: 99%

Targeted Temperature Management: Peltier's Element-Based Focal Brain Cooling Protects Penumbra Neurons from Progressive Damage in Experimental Cerebral Ischemia

Tauchi

Rink

Fujioka

et al. 2018

Therapeutic Hypothermia and Temperature Management

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Targeted temperature management (TTM), or therapeutic hypothermia, is one of the most potent neuroprotective approaches after ischemic and traumatic brain injuries. TTM has been applied clinically with various methods, but effective achievement and maintenance of the target temperature remain challenging. Furthermore, timing of cooling and target body and brain temperature to optimize effectiveness for neuroprotection and to minimize side effects are yet to be standardized. Focal brain cooling is a potential strategy to minimize adverse effects of systemic TTM. In this study, we report on a focal brain cooling device for animals and its effectiveness of focal cooling in several animal models of ischemic cerebral stroke. A focal brain cooling device was constructed using a Peltier's element, a thermoelectric heat pump. The device was validated for its cooling ability, and optimal settings to induce an effective intracranial temperature were determined using male Sprague-Dawley rats. Transient and permanent middle cerebral artery occlusions were experimentally induced, and focal brain cooling was applied using the device varying the timing and duration of cooling. The stroke-induced infarct and edema volumes were evaluated from Nissl-stained cryosections. The focal brain cooling device was able to decrease and subsequently maintained cerebral hypothermia in free-moving rats without altering the core temperature. The device with validated intracranial temperatures produced neuroprotective effects in the acute phase of ischemic neural death, reperfusion injury, progressing damage to the penumbra, and edema formation. In conclusion, our validated focal cooling device enabled rapid and accurate cerebral TTM in rats. Using this device, we were able to test the neuroprotective effect of focal TTM in several pathological stages of cerebral ischemia, which warrants further studies to develop clinically feasible TTM procedures for patients with cerebral stroke.

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“…A preliminary version of this work has been described [24], but this report did not include the experiment in the cat model or the channel structure optimization in the cooling device.…”

Section: Introductionmentioning

confidence: 99%

Epileptic Seizure Suppression by Focal Brain Cooling With Recirculating Coolant Cooling System: Modeling and Simulation

Hata

Fujiwara

Inoue

et al. 2019

IEEE Trans. Neural Syst. Rehabil. Eng.

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A focal brain cooling system for treatment of refractory epilepsy that is implantable and wearable may permit patients with this condition to lead normal daily lives. We have developed such a system for cooling of the epileptic focus by delivery of cold saline to a cooling device that is implanted cranially. The outflow is pumped for circulation and cooled by a Peltier device. Here, we describe the design of the system and evaluate its feasibility by simulation. Mathematical models were constructed based on equations of fluid dynamics and data from a cat model. Computational fluid dynamics simulations gave the following results: 1) a cooling device with a complex channel structure gives a more uniform temperature in the brain; 2) a cooling period of <10 min is required to reach an average temperature of 25.0 • C at 2 mm below the brain surface, which is the target temperature for seizure suppression. This time is short enough for cooling of the brain before seizure onset after seizure prediction by an intracranial electroencephalogrambased algorithm; and 3) battery charging would be required once every several days for most patients. These results suggest that the focal brain cooling system may be clinically applicable.

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Design of focal brain cooling system for suppressing epileptic seizures

Cited by 7 publications

References 19 publications

A focal brain-cooling device as an alternative to electrical stimulation for language mapping during awake craniotomy: patient series

A focal brain-cooling device as an alternative to electrical stimulation for language mapping during awake craniotomy: patient series

Targeted Temperature Management: Peltier's Element-Based Focal Brain Cooling Protects Penumbra Neurons from Progressive Damage in Experimental Cerebral Ischemia

Epileptic Seizure Suppression by Focal Brain Cooling With Recirculating Coolant Cooling System: Modeling and Simulation

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