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Epilepsy and Seizures

Focal Cooling for Drug-Resistant EpilepsyA Review

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JAMA Neurology
Published Online: July 25, 2022
Review
Itamar Niesvizky-Kogan, MD1,2;
Michelle Bass, PhD, MSI, AHIP1;
Shira R. Goldenholz, MD, MPH2;
Daniel M. Goldenholz, MD, PhD1,2
Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Abstract

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.

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Epilepsy and Seizures Neurology
Article Information

Accepted for Publication: May 20, 2022.

Published Online: July 25, 2022. doi:10.1001/jamaneurol.2022.1936

Corresponding Author: Daniel M. Goldenholz, MD, PhD, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Baker 5, Boston, MA 02215 (daniel.goldenholz@bidmc.harvard.edu).

Author Contributions: Drs Goldenholz and Niesvizky-Kogan had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Niesvizky-Kogan, D. Goldenholz.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Niesvizky-Kogan, Bass.

Critical revision of the manuscript for important intellectual content: Niesvizky-Kogan, S. Goldenholz, D. Goldenholz.

Obtained funding: D. Goldenholz.

Administrative, technical, or material support: Niesvizky-Kogan, Bass, D. Goldenholz.

Supervision: D. Goldenholz.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was funded in part by the National Institutes of Health (grant KL2 5KL2TR002542).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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