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Brain Surgery for a ‘Sweet Boy’: Saving Cronutt the 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 — The adolescent patient turned sullen and withdrawn.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

Last-ditch life support system saving COVID-19 patients, study shows

A life support technique called ECMO has saved the lives of many critically ill COVID-19 patients, a new study shows.

The ECMO — extracorporeal membrane oxygenation — machine takes over the function of the lungs and heart. Blood is pumped from the body into equipment that adds oxygen to the blood before it’s returned to the body.

This technique has saved lives in previous epidemics of lung-damaging viruses, but small studies published early in the coronavirus pandemic questioned its effectiveness.

This international study included 1,035 COVID-19 patients at high risk of death because ventilators and other types of care couldn’t support their lungs.

After being placed on ECMO, the death rate among these patients was less than 40%, according to the study authors.

“These results from hospitals experienced in providing ECMO are similar to past reports of ECMO-supported patients, with other forms of acute respiratory distress syndrome or viral pneumonia,” said co-author Dr. Ryan Barbaro, of the University of Michigan.

“The results support recommendations to consider ECMO in COVID-19 if the ventilator is failing. We hope these findings help hospitals make decisions about this resource-intensive option,” Barbaro said in a university news release.

Most centers in this study did not need to use ECMO for COVID-19 very often, said study co-author Graeme MacLaren, of the National University Health System in Singapore.

“By bringing data from over 200 international centers together into the same study, [it] has deepened our knowledge about the use of ECMO for COVID-19 in a way that would be impossible for individual centers to learn on their own,” MacLaren said in the release.

While the study reveals that ECMO can save the lives of COVID-19 patients who show signs of requiring advanced life support, it should be provided at hospitals with experienced ECMO teams, the researchers said. Hospitals shouldn’t try to add ECMO capability in the midst of the COVID-19 pandemic, they added.

The results were published recently in The Lancet medical journal.

More information

The U.S. Centers for Disease Control and Prevention has more on COVID-19.

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