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Novel Brain Surgery Seeks to Reverse Epilepsy in Sea Lion

VALLEJO, Calif. — The adolescent patient turned sullen and withdrawn. He hadn’t eaten in 13 days. Treatment with steroids, phenobarbital and Valium failed to curb the symptoms of his epilepsy. Then, on Sept. 18, he had a terrible seizure — violently jerking his flippers and turning unconscious in the water.

Cronutt, a 7-year-old sea lion, had to be rescued so he didn’t drown. His veterinarian and the caretakers at Six Flags Discovery Kingdom began discussing whether it was time for palliative care.

“We’d tried everything,” said Dr. Claire Simeone, Cronutt’s longtime vet. “We needed more extreme measures.”

On Tuesday morning, Cronutt underwent groundbreaking brain surgery aimed at reversing the epilepsy.

If successful, the treatment could save increasing numbers of sea lions and sea otters from succumbing to a new plague of epilepsy. The cause is climate change.

As oceans warm, algae blooms have become more widespread, creating toxins that get ingested by sardines and anchovies, which in turn get ingested by sea lions, causing damage to the brain that results in epilepsy. Sea otters also face risk when they consume toxin-laden shellfish.

The animals who get stranded on land have been given supportive care, but often die. Cronutt may change that.

“If this works, it’s going to be big,” said Mariana Casalia, a neuroscientist at the University of California, San Francisco, who helped pioneer the techniques that led to a procedure that took place a vet surgery center in Redwood City, Ca.

That procedure was done by three neurosurgeons at U.C.S.F., who ordinarily operate on humans. During the operation, they bored a small hole in Cronutt’s skull, inserted an ultrathin needle into the hippocampus of the sea lion’s brain, then implanted embryonic brain cells extracted from a 35-day-old pig. These so-called “inhibitory cells” tamp down the electrical activity in the brain that leads to seizures, a process identified by Scott Baraban, a professor of neurosurgery who runs the lab where Dr. Casalia works. Over a decade, their technique has proved effective in curing epilepsy in mice.

Credit…Claire Simeone

Cronutt, the first higher mammal to get the treatment, emerged from the surgery and anesthesia midday and was breathing on his own, a first step. Whether the surgery successfully reverses his condition won’t be known for several weeks.

Pig cells are important because they have properties of higher mammal species, including the sea mammals succumbing to epilepsy. And sea lions and sea otters are increasingly at risk for the disease.

The widely documented phenomenon, first discovered in 1998, led to a surge in beaching of sea lions in 2002, another in 2015, and annual summer beachings. By now, thousands of sea lions have been poisoned by the toxin, called domoic acid. It depletes inhibitory cells that ordinarily help offset excitatory cells in the brain’s electrical system. When those cells get out of balance, seizures

Coronavirus cases hit multiweek lows in D.C. region, but experts fear cold weather could reverse trend

But health experts cautioned that there’s no guarantee the numbers will continue to fall, as chillier October weather begins to usher outdoor activities indoors.

Taison Bell, an assistant professor of medicine specializing in infectious diseases and critical care at the University of Virginia in Charlottesville, said the greater Washington region is “in a bit of a steady state” in its number of reported coronavirus cases. The region’s caseload had held steady for several weeks before starting to tick downward about 10 days ago.

He also cautioned that the arrival of cooler weather could increase the spread of the virus as people increasingly decide to congregate indoors.

Neil J. Sehgal, an assistant professor of health policy and management at the University of Maryland School of Public Health, urged residents to consider the pandemic as they make plans for the holidays. They should remember that this is “not the normal holiday season,” he said.

Sehgal said progress in some jurisdictions while battling the virus has started to slow, singling out Prince George’s County, where outbreaks have been reported at the University of Maryland. He said other college towns in the region, including Virginia’s Blacksburg and Charlottesville, also have seen caseloads rise as students go back to school.

“We haven’t controlled transmissions,” Sehgal said. “We’re still riding our first wave of the outbreak. We saw a summer dip, but we never stamped it out. There are still chains of transmission in the community.”

Short of a vaccine, Sehgal said, recent days are probably “as safe as it’s going to be” in terms of a lowered number of cases in the Washington region, also noting the likelihood of increased spread as the weather turns colder.

Still, D.C., Maryland and Virginia have made progress in battling the virus in recent days.

The seven-day rolling average of new cases in Washington’s Northern Virginia suburbs stood at 190 on Wednesday, with the region this week notching its lowest average caseloads since early August. Statewide, the number of new daily cases is the lowest since mid-July.

In D.C., the seven-day average dropped to 39 on Wednesday, the lowest in the city since early July.

Maryland’s seven-day average stood at 490 on Wednesday, up slightly in recent days but about half the number of daily cases as early August. Caseloads have held mostly steady in Montgomery and Prince George’s counties in recent weeks.

Montgomery County officials said Wednesday that they are continuing to accumulate supplies in preparation for a possible increase in coronavirus cases this fall or winter.

“We are in a lot better position than we were in the spring,” County Executive Marc Elrich (D) said at a news conference. “We made a decision in the beginning that we would accumulate enough supplies for a second surge.”

Among the supplies are 50 new ventilators that arrived this summer, officials said.

The seven-day rolling average of new cases in the county stood at 83 on Wednesday, with a test positivity rate of 2.6 percent. County health officer Travis Gayles