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March 2008, Volume 58, Issue 3

Letter to the Editor

Hypothermia therapy, neuroprotection and meaningful brain recovery

Muhammad U. Farooq  ( Department of Neurology and Ophthalmology, Michigan State,University, East Lansing, Michigan, USA )

Madam, We read the recently published article "Therapeutic Hypothermia: Keeping cool inside" by Zeeshan Mahmood1 with great interest. We have some additional comments elaborating the clinical implications of this promising neuroprotective therapy.  We agree that therapeutic hypothermia (TH) has cardioprotective effect and if initiated during extended ischaemia/early reperfusion period, it optimally protects cardiomyocytes from ischaemic insult.2 We would like to highlight neuroprotection as the main reason for a resurgence of interest in hypothermia treatment, which was touched on by the author but does not stand out from this article.1 It has been observed that even small decreases in brain or body temperature result in marked attenuation of ischaemic brain injury.3,4 One of the main indications of TH is in patients with out-of-hospital cardiac arrest as mentioned by Zeeshan Mahmood. With reference to the last sentence of his article1 we agree that TH helps these patients to maintain a normal lifestyle due to "healthy heart". However, the protection afforded by TH may go beyond the heart to include a neuroprotective effect and allow for meaningful brain recovery in patients who suffer from cardiac arrest, stroke, acute traumatic brain injury and neonatal asphyxia. TH is an evidence-based intervention strategy and there is a need for improved awareness and education regarding this treatment option. While clinically induced hypothermia is beneficial as a treatment to preserve neurologic function, it is not without complications (such as electrolyte and coagulation abnormalities) and these should be carefully watched in these patients.5

References

1. Mahmood Z. Therapeutic hypothermia: keeping cool inside. J Pak Med Assoc. 2007;57: 620-1.
2. Shao ZH, Chang WT, Chan KC, Wojcik KR, Hsu CW, Li CQ, et al. Hypothermia-induced cardioprotection using extended ischemia and early reperfusion cooling. Am J Physiol Heart Circ Physio. 2007;292:H1995-2003.
3. Ginsberg MD, Sternau LL, Globus MY, Dietrich WD, Busto R. Therapeutic modulation of brain temperature: relevance to ischemic brain injury. Cerebrovasc Brain Metab Rev. 1992;4:189-225
4. Barone FC, Feuerstein GZ, White RF. Brain cooling during transient focal ischemia provides complete neuroprotection. Neurosci Biobehav Rev. 1997;21:31-44
5. Aibiki M. Practical aspects and prevention of complications during therapeutic hypothermia. Intensive Care Med 2004;30:2286.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: