Epilepsy can result from genetics or brain damage. Traumatic head injury is the leading cause of acquired epilepsy in young adults. It is often difficult to manage with antiepileptic drugs. The mechanisms  behind the onset of epileptic seizures after brain injury are not known . There is currently no treatment to cure it, prevent it, or even limit its severity.

The multi-institutional research team used a rodent model of acquired epilepsy in which animals develop chronic spontaneous recurrent seizures -the hallmark of epilepsy- after a contusive head injury similar to that causing epilepsy in humans.  The rats were randomized to either mock-cooling or cooling of the contused brain by no more than 2 Celsius degrees. This degree of cooling, the authors explained, is known to be safe and to decrease mortality of patients with head injury.  The rats  were then monitored for four months after injury and epilepsy was evaluated by intracranial EEG. The contused brain was cooled continuously with special headsets engineered to passively dissipate heat. No Peltier cells or other power sources for refrigeration were needed.

The investigators report that cooling by just 2 degrees celsius for 5 weeks beginning 3 days after injury virtually abolished the later development of epileptic seizure activity. This effect persisted through the end of the study. The treatment induced no additional pathology or inflammation, and restored neuronal activity depressed by the injury.

“These findings demonstrate for the first time that prevention of epileptic seizures after traumatic brain brain injury is possible, and that epilepsy prophylaxis in patients could be achieved more easily than previously thought, said  the lead author of the study,  Raimondo D’Ambrosio, 91Ě˝»¨associate professor of neurological surgery.  He added that a clinical trial is required to verify the findings in head injury patients.

In addition to D’Ambrosio,  the research team from the 91Ě˝»¨Â included  John W. Miller, professor of neurology and director of the 91Ě˝»¨Regional Epilepsy Center;   Nancy R. Temkin, professor of neurological surgery and biostatistics; and  Jeffrey G. Ojemann, professor of neurological surgery. Other members of the team were  Steven M. Rothman, professor of pediatrics and director, Clinical Neurosciences in Pediatrics at the University of Minnesota  and  Matthew D. Smyth, professor of pediatrics and neurosurgery at Washington University in St. Louis.

Their “Mild passive focal cooling prevents epileptic seizures after head injury in rats” was funded by CURE Epilepsy in partnership with the United States Army Medical Research and Materiel Command.

At 2:30 a.m. Aug. 21 in Seattle, 91Ě˝»¨Medicine vascular surgeon Dr. Benjamin Starnes consulted by phone with the cruise physician.  Starnes advised on the impending need for a type of treatment not available on the ship.

The ship’s physician advised the captain, who  asked for a U.S. Coast Guard helicopter to be dispatched to the cruise ship for a medical evacuation. The ship’s passengers were informed of the rescue operation.

Sarah Davis’ husband of 64 years was sad and worried as his wife was strapped into a litter tethered to the rescue helicopter hovering overhead. Sarah  Davis recalled the tethered basket  “twirling a bit in the air a bit” as she was raised toward the helicopter.

After she was securely on board, the helicopter turned away from the ship, grew smaller and disappeared into the sky on its way toward Juneau. Davis was stabilized at a Juneau hospital, then transferred via a medical flight to Harborview Medical Center.

91Ě˝»¨Medicine vascular surgeon Dr. Benjamin Starnes and his team were at Harborview ready to provide urgent treatment for her leg. Davis was later admitted to the Intensive Care Unit. One of the surgical residents at Harborview was originally from her intercoastal town near Savannah, Ga., and Hilton Head, S.C. The resident’s visits helped her feel not so far from home.

Starnes scheduled surgery to remove a.blood clot Thursday, August 23.  In the meantime, her family had left Alaska and flown to Seattle.  Her husband held her hand as they waited for her to be wheeled away to surgery. “I love this gal,” he said.

Sarah Davis expressed in her warm Southern accent her gratitude to the ship’s physician, the cruise personnel, Coast Guard crew, her Juneau hospital care staff, the  medical airlift team to Seattle, and Harborview Medical Center. Her husband was thankful for the prompt treatment his wife received due to the urgent nature of her condition.

Mrs. Davis is now recovering at Harborview and will be heading home in the next few days.

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