Beyond Prediction — Focal Cooling and Optical Activationto Terminate Focal Seizures

摘要

When the science of human seizure prediction and detection matures, there willbe a plethora of practical questions about how to best implement these powerfultechniques. While knowledge of the likelihood of an impending seizure wouldof course be very significant, indeed empowering, for patients, it would be evenmore desirable if some reliable method of seizure prevention could be rapidlyactivated. The known antiepileptic effect of cooling makes local cortical coolingone potential therapeutic strategy. Recent advances in the fabrication of small,electric cooling devices (thermoelectric or Peltier) has raised the possibility ofincorporating an implantable cooling unit into a closed loop seizure detectionsystem. Another possible strategy for focal seizure prevention or terminationwould be to combine a small, powerful ultraviolet light-emitting diode (UV LED)with local administration of a caged version of the inhibitory transmitter y-aminobutryic acid (GABA). Seizure prediction could activate the LED, releasingGABA to suppress focal paroxysmal activity. Support for both of these strategiesexists in a variety of experimental systems; adapting them for clinical use is thenext challenge.