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Summary: Purpose:The therapy for focal neocortical epilepsy remains suboptimal. We have, therefore, worked to develop techniques to cool small regions of the neocortical surface for seizure mapping and, ultimately, for long-term suppression of focal seizures.Methods: We induced focal neocortical seizures in halothane-anesthetized rats by the microinjection of 4-aminopyridine (4-AP) into the motor cortex. The dura over the injection site was cooled with a Peltier device, and the temperature at the interface between dura and Peltier was measured with a thermocouple. In some experiments, seizures were automatically detected by a computer program that activated the Peltier device.Results: Monopolar EEG indicated that our seizures were focal and suppressed when cooling was applied directly over the injection site. The threshold temperature required to observe any reduction in seizure duration was 24°C. The temperature gradient across the cooled neocortex was sharp, with the temperature increasing to 31°C at 4 mm below the Peltier, which was cooled to 20°C. Automatic seizure detection reduced the total seizure duration from 43.4 ± 33.6 s to 5.6 ± 5.3 s.Conclusions: Cooling terminates neocortical seizures when applied very close to the epileptogenic focus. The threshold for seizure termination (24°C) may be lower than the threshold for termination of normal cortical activity, suggesting that this technique will not dissociate the anticonvulsant effect of cooling from the disruption of normal behavior. However, when coupled with automatic seizure detection, focal cooling remains an attractive option for development as a treatment for focal epilepsy.

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Patients with diabetes and peripheral neuropathy are susceptible to unnoticed trauma on the foot that can cause skin breakdown. We have designed an electronic system in a shoe that monitors temperature, pressure, and humidity, storing the data in a battery-powered device for later uploading to a host computer for data analysis. The pressure sensors are located at the heel, and under three metatarsal heads. Temperature sensors are located under the medial metatarsal head and under the heel. The humidity sensor is located in the toe of the shoe. Correlations of data from pressure sensors with known values were high (r > 0.85), even after extended use. Although data currently are being collected for descriptive purposes, the design potentially can be used to provide feedback to patients.