Seizure-induced changes in place cell physiology: relationship to spatial memory

Instability of spatial encoding by CA1 hippocampal place cells after peripheral nerve injury

Several authors have shown that the hippocampus responds to painful stimulation and suggested that prolonged painful conditions could lead to abnormal hippocampal functioning. The aim of the present study was to evaluate whether the induction of persistent peripheral neuropathic pain would affect basic hippocampal processing such as the spatial encoding performed by CA1 place cells. These place cells fire preferentially in a certain spatial position in the environment, and this spatial mapping remains stable across multiple experimental sessions even when the animal is removed from the testing environment. To address the effect of prolonged pain on the stability of place cell encoding, we chronically implanted arrays of electrodes in the CA1 hippocampal region of adult rats and recorded the multichannel neuronal activity during a simple food-reinforced alternation task in a U-shaped runway. The activity of place cells was followed over a 3-week period before and after the establishment of an animal model of neuropathy, spared nerve injury. Our results show that the nerve injury increased the number of place fields encoded per cell and the mapping size of the place fields. In addition, there was an increase in in-field coherence while the amount of spatial information content that a single spike conveyed about the animal location decreased over time. Other measures of spatial tuning (in-field firing rate, firing peak and number of spikes) were unchanged between the experimental groups. These results demonstrate that the functioning of spatial place cells is altered during neuropathic pain conditions.

Dravet syndrome and SCN1A gene mutation related-epilepsies: cognitive impairment and its determinants

Some studies have demonstrated that cognitive decline occurs in Dravet syndrome, starting shortly after the onset of seizures, rapidly progressing and then plateauing within a few years. It is unclear whether children that develop the syndrome had entirely normal cognitive skills before seizure onset, since subtle impairment easily escapes recognition in small infants. It is also difficult to demonstrate whether a recognisable profile of cognitive impairment or a definite behavioural phenotype exists. No clear-cut imaging or neuropathological marker or substrate has been recognised for cognitive impairment in this syndrome. However, there are different potentially causative factors, including the specific effects on the Nav1.1 channels caused by the underlying genic or genomic defect; frequent and prolonged convulsive and non-convulsive seizures or status epilepticus; recurrent subtle ictal phenomena, such as that accompanying pronounced visual sensitivity; the use of antiepileptic drugs with cognitive side effects, especially in heavy multiple-drug therapy; and the restrictions that children with severe epilepsy inevitably undergo.

Vascular endothelial growth factor attenuates status epilepticus-induced behavioral impairments in rats

Vascular endothelial growth factor (VEGF) is a vascular growth factor more recently recognized as a neurotrophic factor (for review, see Storkebaum E, Lambrechts D, Carmeliet P. BioEssays 2004;26:943-54). We previously reported that endogenous VEGF protein is dramatically upregulated after pilocarpine-induced status epilepticus in the rat, and that intra-hippocampal infusions of recombinant human VEGF significantly protected against the loss of hippocampal CA1 neurons in this model (Nicoletti JN, Shah SK, McCloskey DP, et al. Neuroscience 2008;151:232-41). We hypothesized that we would see a preservation of cognitive and emotional functioning with VEGF treatment accompanying the neuroprotection previously observed in this paradigm. Using the Morris water maze to evaluate learning and memory, and the light-dark task to assess anxiety, we found a selective profile of preservation. Specifically, VEGF completely preserved normal anxiety functioning and partially but significantly protected learning and memory after status epilepticus. To determine whether the ability of VEGF to attenuate behavioral deficits was accompanied by sustained preservation of hippocampal neurons, we stereologically estimated CA1 pyramidal neuron densities 4 weeks after status epilepticus. At this time point, we found no significant difference in neuronal densities between VEGF- and control-treated status epilepticus animals, suggesting that VEGF could have protected hippocampal functioning independent of its neuroprotective effect.

Epilepsy and forgetfulness: one impairment, multiple mechanisms

Impaired Single Cell Firing and Long-term Potentiation Parallels Memory Impairment Following Recurrent Seizures. Zhou JL, Shatskikh TN, Liu X, Holmes GL. Eur J Neurosci 2007;25(12):3667–3677. Patients with epilepsy are at substantial risk for memory impairment. Animal studies have paralleled these clinical observations, demonstrating impaired hippocampal function as measured by spatial memory in rodents subjected to seizures. However, the mechanism of seizure-induced hippocampal impairment is unclear. Here we investigated the effects of recurrent seizures on water-maze performance, a behavioural measure of learning and memory, long-term potentiation (LTP; considered a test of synaptic plasticity and memory) and place-cell firing patterns, a single-cell indicator of spatial memory. LTP and CA1 place-cell activity were examined in separate groups of freely moving rats, before and after 10 flurothyl-induced seizures. Water maze performance was examined in a third group of rats, five with previously induced seizures and five controls. Recurrent flurothyl seizures were associated with marked impairment in LTP and a reduction in the frequency of the peak theta power. Compared to baseline recordings, place-cell firing patterns following recurrent seizures were significantly less precise, had lower firing rates and were less stable. Impaired place-cell firing was seen as early as after two seizures and persisted at least 72h after the last seizure. Water-maze performance was also significantly impaired in animals that underwent recurrent seizures. No cell loss or synaptic reorganization was observed in the hippocampus or in several other cortical areas that are vulnerable to seizures. These results demonstrate that relatively brief excitatory events, not producing visible cell damage, can nevertheless cause long-lasting changes in hippocampal physiology, observable as impairments in place-cell function, LTP and spatial memory.

The long-term effects of neonatal seizures

The highest incidence of seizures occurs during the first hours to days after birth. The immature brain is prone to seizures because of reduced inhibition. GABA, which is the primary inhibitory neurotransmitter in the mature brain, is depolarizing and excitatory in the immature brain. Seizures are an ominous sign, indicating either an acquired brain insult or a genetic abnormality. While the primary outcome determinant of neonatal seizures is etiology, whether seizures can result in long-term adverse consequences independently is not clear. While the clinical data is uncertain, there is now a considerable body of evidence indicating that in animals, neonatal seizures can adversely alter the developing brain. Animal data indicates that the sequelae of seizures are strongly age dependent; seizures will affect the developing and plastic neuronal circuitry much differently than the fixed circuitry of the mature brain. Seizures at an early developmental stage can dramatically affect the construction of networks, resulting in severe and permanent handicaps in some patients. In the young brain, the long-lasting detrimental consequences of seizures are caused by an alteration of developmental programs rather than by neuronal cell loss, as occurs in adults. In animal models, neonatal seizures result in decreases in neurogenesis, sprouting of mossy fibers, and long-standing changes in signaling properties. Seizures in rat pups are also associated with abnormalities in firing patterns of single cells in the hippocampus. Furthermore, these anatomic and physiologic changes correlate well with behavioral dysfunction.

The 2008 Judith Hoyer lecture: epilepsy in children: listening to mothers

The incidence of epilepsy is significantly higher in children than adults. When faced with the diagnosis of epilepsy, parents have many questions regarding cause, treatment, and prognosis. Although the majority of children with epilepsy have an excellent prognosis and respond well to therapy, some children are refractory to therapy and suffer from cognitive decline. Animal models are now providing insights into the mechanisms responsible for the high incidence of seizures during development and age-dependent seizure-induced damage. One of the causes of the increased susceptibility of the young brain to seizures is the depolarizing effects of GABA secondary to high intracellular concentrations of chloride in young neurons. Although cell loss is not a feature of seizures in the young brain, recurrent seizures do result in aberrant sprouting of mossy fibers, reduce neurogenesis, and alter excitatory and inhibitory neurotransmitter receptor structure and function. Behavioral consequences of early-life seizures include impaired spatial cognition, which now can be assessed using single-cell recordings from the hippocampus. Antiepileptic drugs have had a tremendous positive influence in epilepsy management, although there are now a number of studies demonstrating that antiepileptic drugs at therapeutic concentrations can impair cognition and result in increased apoptosis. While clinical judgment and experience are paramount when discussing the consequences of seizures and their treatment, awareness of studies from animals can provide the clinician with guidance in addressing these important issues with parents.

The epileptic hypothesis: developmentally related arguments based on animal models

The significant morbidity linked to epileptic encephalopathies of childhood has prompted the need to identify and dissect the factors and mechanisms that contribute to the resultant functional regression. Although experiments specifically assessing language in rodents are difficult to design, a number of studies have shed light on the conditions that contribute to the functional deterioration. In particular, interictal spikes and seizures, especially if prolonged or frequent, may cause acute or long-lasting effects on brain functioning and development, which may impair performance in a variety of behavioral tests. These effects are further modified by a number of genetic, biological, and epigenetic factors, including age, sex, and underlying pathology, which further diversify outcome. Of special importance is the developmental age when the epileptic disorder manifests, because it may dictate outcome but also may be a deciding factor in selecting appropriate therapies.

A selective interplay between aberrant EPSPKA and INaP reduces spike timing precision in dentate granule cells of epileptic rats

Spike timing precision is a fundamental aspect of neuronal information processing in the brain. Here we examined the temporal precision of input–output operation of dentate granule cells (DGCs) in an animal model of temporal lobe epilepsy (TLE). In TLE, mossy fibers sprout and establish recurrent synapses on DGCs that generate aberrant slow kainate receptor–mediated excitatory postsynaptic potentials (EPSP_KA) not observed in controls. We report that, in contrast to time-locked spikes generated by EPSP_AMPA in control DGCs, aberrant EPSP_KA are associated with long-lasting plateaus and jittered spikes during single-spike mode firing. This is mediated by a selective voltage-dependent amplification of EPSP_KA through persistent sodium current (I_NaP) activation. In control DGCs, a current injection of a waveform mimicking the slow shape of EPSP_KA activates I_NaP and generates jittered spikes. Conversely in epileptic rats, blockade of EPSP_KA or I_NaP restores the temporal precision of EPSP–spike coupling. Importantly, EPSP_KA not only decrease spike timing precision at recurrent mossy fiber synapses but also at perforant path synapses during synaptic integration through I_NaP activation. We conclude that a selective interplay between aberrant EPSP_KA and I_NaP severely alters the temporal precision of EPSP–spike coupling in DGCs of chronic epileptic rats.

Effect of age on cognitive sequelae following early life seizures in rats

PURPOSE

Clinical studies have suggested that seizures in newborns are more damaging than seizures occurring in older children. However, these studies are difficult to interpret for a variety of factors including differing etiologies of seizures across ages. Animal studies can provide insights into the question of whether age of seizure onset in children is a factor in cognitive outcome.

METHODS

To evaluate the effect of age on seizure-induced cognitive impairment we subjected rats to 50 seizures from postnatal days P0-P10 or P15-P25. As adults the rats were studied in the Morris water maze, radial-arm water maze, open field, and active avoidance. To assess synaptic strength and network excitatory and inhibitory function animals were evaluated with long-term potentiation (LTP) and paired-pulse facilitation/inhibition.

RESULTS

Compared to controls, both groups of rats with recurrent seizures were impaired in spatial memory in both water maze tests, had altered activity in the open field, and did not differ from controls in active avoidance. Rats with recurrent seizures had impaired LTP but showed no deficits in paired-pulse facilitation or inhibition. While rats with later onset showed a trend to worse performance than rats with earlier seizures, the differences were not substantial.

CONCLUSIONS

Recurrent seizures during development are associated with long-term behavioral deficits in learning, memory and activity level as well as impaired synaptic efficiency. Age of seizure onset was not a strong predictor of outcome.

Early life seizures cause long-standing impairment of the hippocampal map

Children with seizures are at risk for long-term cognitive deficits. Similarly, recurrent seizures in developing rats are associated with deficits in spatial learning and memory. However, the pathophysiological bases for these deficits are not known. Hippocampal place cells, cells that are activated selectively when an animal moves through a particular location in space, provides the animal with a spatial map. We hypothesized that seizure-induced impairment in spatial learning is a consequence of the rat's inability to form accurate and stable hippocampal maps. To directly address the cellular concomitants of spatial memory impairment, we recorded the activity of place cells from hippocampal subfield CA1 in freely moving rats subjected to 100 brief flurothyl-induced seizures during the first weeks of life and then tested them in the Morris water maze and radial-arm water maze followed by place cell testing. Compared to controls, rats with recurrent seizures had marked impairment in Morris water maze and radial-arm water maze. In parallel, there were substantial deficits in action potential firing characteristics of place cells with two major defects: i) the coherence, information content, center firing rate, and field size were reduced compared to control cells; and ii) the fields were less stable than those in control place cells. These results show that recurrent seizures during early development are associated with significant impairment in spatial learning and that these deficits are paralleled by deficits in the hippocampal map. This study thus provides a cellular correlate for how recurrent seizures during early development lead to cognitive impairment.

Cognitive dysfunction after experimental febrile seizures

While the majority of children with febrile seizures have an excellent prognosis, a small percentage are later discovered to have cognitive impairment. Whether the febrile seizures produce the cognitive deficits or the febrile seizures are a marker or the result of underlying brain pathology is not clear from the clinical literature. We evaluated hippocampal and prefrontal cortex function in adult rats with a prior history of experimental febrile seizures as rat pups. All of the rat pups had MRI brain scans following the seizures. Rats subjected to experimental febrile seizures were found to have moderate deficits in working and reference memory and strategy shifting in the Morris water maze test. A possible basis for these hippocampal deficits involved abnormal firing rate and poor stability of hippocampal CA1 place cells, neurons involved in encoding and retrieval of spatial information. Additional derangements of interneuron firing in the CA1 hippocampal circuit suggested a complex network dysfunction in the rats. MRI T2 values in the hippocampus were significantly elevated in 50% of seizure-experiencing rats. Learning and memory functions of these T2-positive rats were significantly worse than those of T2-negative cohorts and of controls. We conclude that cognitive dysfunction involving the hippocampus and prefrontal cortex networks occur following experimental febrile seizures and that the MRI provides a potential biomarker for hippocampal deficits in a model of prolonged human febrile seizures.

Effect of topiramate on cognitive function and single units from hippocampal place cells following status epilepticus

Topiramate, an antiepileptic drug with multiple mechanisms of action, was assessed as a neuroprotective agent following status epilepticus. We administered topiramate or normal saline chronically beginning 1 hour after cessation of lithium pilocarpine-induced status epilepticus. Control animals not subjected to status epilepticus were also treated with topiramate or normal saline. Following completion of the topiramate treatment, animals were tested in the water maze to assess spatial learning and underwent in vivo single-cell place cell recordings. Spontaneous seizure frequency following status epilepticus in the topiramate-treated rats was similar to that in the rats treated with saline. Following status epilepticus, rats had profound deficits in water maze performance and place cell function. Rats subjected to status epilepticus and treated with topiramate were also severely impaired in the water maze, but performed slightly better than rats treated with saline. Following status epilepticus, topiramate-treated rats did not differ from rats treated with normal saline in the platform switch, a test of prefrontal function. Although place cell firing patterns were similar in both the topiramate- and saline-treated rats, rats treated with topiramate had higher information content scores than rats treated with saline. Topiramate-treated animals had less supragranular sprouting following status epilepticus than nontreated rats. Control animals treated with topiramate did not differ from saline-treated controls on any measures. Taken together, this study shows that topiramate administered following status epilepticus has modest neuroprotective effects.

h channel-dependent deficit of theta oscillation resonance and phase shift in temporal lobe epilepsy

I(h) tunes hippocampal CA1 pyramidal cell dendrites to optimally respond to theta inputs (4-12 Hz), and provides a negative time delay to theta inputs. Decreased I(h) activity, as seen in experimental temporal lobe epilepsy (TLE), could significantly alter the response of dendrites to theta inputs. Here we report a progressive erosion of theta resonance and phase lead in pyramidal cell dendrites during epileptogenesis in a rat model of TLE. These alterations were due to decreased I(h) availability, via a decline in HCN1/HCN2 subunit expression resulting in decreased h currents, and altered kinetics of the residual channels. This acquired HCN channelopathy thus compromises temporal coding and tuning to theta inputs in pyramidal cell dendrites. Decreased theta resonance in vitro also correlated with a reduction in theta frequency and power in vivo. We suggest that the neuronal/circuitry changes associated with TLE, including altered I(h)-dependent inductive mechanisms, can disrupt hippocampal theta function.

Changes in Granule Cell Firing Rates Precede Locally Recorded Spontaneous Seizures by Minutes in an Animal Model of Temporal Lobe Epilepsy

Although much is known about persistent molecular, cellular, and circuit changes associated with temporal lobe epilepsy, mechanisms of seizure onset remain unclear. The dentate gyrus displays many persistent epilepsy-related abnormalities and is in the mesial temporal lobe where seizures initiate in patients. However, little is known about seizure-related activity of individual neurons in the dentate gyrus. We used tetrodes to record action potentials of multiple, single granule cells before and during spontaneous seizures in epileptic pilocarpine-treated rats. Subsets of granule cells displayed four distinct activity patterns: increased firing before seizure onset, decreased firing before seizure onset, increased firing only after seizure onset, and unchanged firing rates despite electrographic seizure activity in the immediate vicinity. No cells decreased firing rate immediately after seizure onset. During baseline periods between seizures, action potential waveforms and firing rates were similar among the four subsets of granule cells in epileptic rats and in granule cells of control rats. The mean normalized firing rate of granule cells whose firing rates increased before seizure onset deviated from baseline earliest, beginning 4 min before dentate gyrus electrographic seizure onset, and increased progressively, more than doubling by seizure onset. It is generally assumed that neuronal firing rates increase abruptly and synchronously only when electrographic seizures begin. However, these findings show heterogeneous and gradually building changes in activity of individual granule cells minutes before spontaneous seizures.

Neurobiological mechanisms of developmental epilepsy: translating experimental findings into clinical application

Although seizures are very common during early brain development, consequences of seizures during this age period are less severe than in the mature brain. Reasons for this discrepancy relate to both the sequential development of neural elements (ion channels, neurotransmitters, synapses, and circuits) and the effects of seizures on these ongoing processes at different ages. In this review, I critically discuss 2 recent experimental trends in developmental neurobiology that impact seizures and their consequences. First, the paradoxic excitatory effects of gamma-aminobutyric acid early in life are related to seizure susceptibility in this developmental period. Second, the plasticity of immature neuronal circuits and the effects of seizures on subsequent cognition and behavior as a function of age are considered. These topics are relevant to the pediatric neurologist when evaluating and treating a young child with seizures.

Characterization of neonatal seizures by conventional EEG and single-channel EEG

OBJECTIVE

To perform a detailed, contemporary temporal-spatial characterization of neonatal seizures (NS) and to compare conventional EEG (CEEG) to single-channel EEG for NS detection.

METHODS

Digitally recorded CEEGs were reviewed for NS characteristics (quantity, duration, location of onset, peak-to-peak amplitude). The presence and characteristics of each NS were simultaneously noted in a single, derived EEG channel (C3-->C4).

RESULTS

Eight hundred fifty-one seizures from 125 CEEGs recorded were analyzed. Mean seizure rate was 7.0 NS/h (range: 0.5-21). Mean seizure burden (percent time CEEG showed NS at any location) was 24.8% (range: 0.7-86.9). Seizure rate was only moderately correlated with seizure burden (Spearman coefficient=0.58). Eighty-one percent of NS originated from central-temporal or midline vertex electrodes. Seventy-eight percent of NS appeared in the C3-->C4 channel.

CONCLUSIONS

Accurate measurement of NS burden requires detailed temporal-spatial characterization. The theoretical ceiling of sensitivity for NS detection in the single EEG channel C3-->C4 is high. However, further processing the raw EEG in limited electrode arrays may reduce the sensitivity of NS detection.

SIGNIFICANCE

CEEG is the gold standard for NS detection. However, reduced montage EEG techniques are increasingly available. This detailed contemporary temporal-spatial characterization of NS evaluates the potential limitations of reduced montage techniques.

Sensitivity of amplitude-integrated electroencephalography for neonatal seizure detection

BACKGROUND

Conventional electroencephalography remains the gold standard for the diagnosis and quantification of neonatal seizures. However, amplitude-integrated electroencephalography (aEEG) is being introduced to neonatal intensive care as an adjunct for neonatal seizure detection.

OBJECTIVES

This study's purpose was to determine the sensitivity of neonatal seizure detection in a single electroencephalogram channel (C3-->C4), used to simulate the raw signal from which aEEG is derived. We also aimed to determine the sensitivity of seizure detection by neonatologists by using aEEG and to establish those neonatal seizure characteristics that are associated with their correct detection by aEEG.

METHODS

Conventional electroencephalograms with neonatal seizures were reviewed for electroencephalogram background and neonatal seizure characteristics (site of onset, duration, and peak-to-peak amplitude). The presence, duration, and peak-to-peak amplitude of each seizure were simultaneously noted in a single electroencephalogram channel (C3-->C4). aEEGs generated from this channel were reviewed for background and seizures by 6 neonatologists with varying aEEG interpretation expertise.

RESULTS

A total of 851 neonatal seizures from 125 conventional electroencephalograms were analyzed. The patients' conceptional ages were 34 to 50 weeks. Because 94% of the conventional electroencephalograms had > or = 1 neonatal seizure visible in C3-->C4, and 78% of all neonatal seizures appeared in the C3-->C4 channel, the theoretical sensitivity of seizure detection in a single electroencephalogram channel was high. However, seizures were briefer and lower in amplitude in C3-->C4 compared with conventional electroencephalography. Neonatologists identified seizures in 22% to 57% of the 125 records of neonatal seizure. They detected 12% to 38% of the 851 individual seizures. Multivariate analysis revealed that the appearance of seizures in C3-->C4, neonatal seizure duration, seizure amplitude, seizure count per hour, and neonatologists' experience with aEEG interpretation all correlated with neonatal seizure detection.

CONCLUSIONS

Even among physicians who have extensive experience, many neonatal seizures are difficult to detect on an aEEG, especially when they are infrequent, brief, or of low amplitude.

Impaired single cell firing and long-term potentiation parallels memory impairment following recurrent seizures

Patients with epilepsy are at substantial risk for memory impairment. Animal studies have paralleled these clinical observations, demonstrating impaired hippocampal function as measured by spatial memory in rodents subjected to seizures. However, the mechanism of seizure-induced hippocampal impairment is unclear. Here we investigated the effects of recurrent seizures on water-maze performance, a behavioural measure of learning and memory, long-term potentiation (LTP; considered a test of synaptic plasticity and memory) and place-cell firing patterns, a single-cell indicator of spatial memory. LTP and CA1 place-cell activity were examined in separate groups of freely moving rats, before and after 10 flurothyl-induced seizures. Water maze performance was examined in a third group of rats, five with previously induced seizures and five controls. Recurrent flurothyl seizures were associated with marked impairment in LTP and a reduction in the frequency of the peak theta power. Compared to baseline recordings, place-cell firing patterns following recurrent seizures were significantly less precise, had lower firing rates and were less stable. Impaired place-cell firing was seen as early as after two seizures and persisted at least 72 h after the last seizure. Water-maze performance was also significantly impaired in animals that underwent recurrent seizures. No cell loss or synaptic reorganization was observed in the hippocampus or in several other cortical areas that are vulnerable to seizures. These results demonstrate that relatively brief excitatory events, not producing visible cell damage, can nevertheless cause long-lasting changes in hippocampal physiology, observable as impairments in place-cell function, LTP and spatial memory.

Postictal single-cell firing patterns in the hippocampus

PURPOSE

Patients with epilepsy have varying degrees of postictal impairment including confusion and amnesia. This impairment adds substantially to the disease burden of epilepsy. However, the mechanism responsible for postictal cognitive impairment is unclear. The purpose of this study was to study single-cell firing patterns in hippocampal cells after spontaneous seizures in rats previously subjected to status epilepticus.

METHODS

In this study, we monitored place cells and interneurons in the CA1 region of the hippocampus before and after spontaneous seizures in six epileptic rats with a history of status epilepticus. Place cells fire action potentials when the animal is in a specific location in space, the so-called place field. Place cell function correlates well with performance in tasks of visual-spatial memory and appears to be an excellent surrogate measure of spatial memory.

RESULTS

Twelve spontaneous seizures were recorded. After the seizures, a marked decrease in firing rate of action potentials from place cells was noted, whereas interneuron firing was unchanged. In addition, when place cell firing fields persisted or returned, they had aberrant firing fields with reduced coherence and information content. In addition to postictal suppression of firing patterns, seizures led to the emergence of firing fields in previously silent cells, demonstrating a postictal remapping of the hippocampus.

CONCLUSIONS

These findings demonstrate that postictal alterations in behavior are not due solely to reduced neuronal firing. Rather, the postictal period is characterized by robust and dynamic changes in cell-firing patterns resulting in remapping of the hippocampal map.

Treatment of late lithium-pilocarpine-induced status epilepticus with diazepam

PURPOSE

It is well known that status epilepticus (SE) becomes increasingly difficult to control over time. Previous studies have indicated that the electroencephalographic pattern at the time of intervention is predictive of the probability of successful treatment. However, these findings are based on studies limited to the first 2h of SE onset. Little data is available on the efficacy of treating SE at later time points.

METHODS

The aim of the present study was to investigate the efficacy of diazepam (DZP) treatment given at two different phases of SE in a lithium-pilocarpine rat model: during continuous ictal discharges (CIDs, phase 3), and during late periodic epileptiform discharges (late PEDs, phase 5). Changes in cortical and hippocampal electroencephalographs (EEGs) were observed continuously during the phases of SE, as well as at 24, 36, 48, and 72h after SE onset. The effects of DZP treatment during CIDs or during late PEDs were compared to control DZP-untreated rats.

RESULTS

In all three groups, hippocampal and cortical EEGs displayed five distinct phases of SE. There were no statistical differences in the duration of phases 1 and 2 among the three groups. Although DZP administration during CIDs did not terminate CIDs in most rats, it did significantly shorten the duration of phases 3 and 4 of SE. Importantly, DZP given during phase 5 successfully ended behavioral and electrographic seizures in most rats.

CONCLUSIONS

Hippocampal and cortical EEGs displayed five distinct phases of SE that were similarly responsive to DZP treatment. Termination of electrographic seizures with DZP treatment was more effective in the last phase of SE (late PEDs) than in phase 3 (CIDs). These findings suggest that previous reports of DZPs decrease in efficacy over time may not be applicable to DZP treatment at 4h-post onset.

Effect of interictal spikes on single-cell firing patterns in the hippocampus

PURPOSE

The interictal EEG spike(s) is the hallmark of the epileptic EEG. While focal interictal spike (IS) have been associated with transitory cognitive impairment, with the type of deficit dependent on where in the cortex the IS arises, the mechanism by which IS result in transitory dysfunction is not known. The purpose of this study was to determine the effect of IS on single-cell firing patterns in freely moving rats with a prior history of seizures.

METHODS

We studied IS in two seizure models; pilocarpine-induced status epilepticus and recurrent flurothyl models. The effect of spontaneous hippocampal spikes on action potentials (APs) of CA1 cells in rats walking in a familiar environment was investigated using 32 extracellular electrodes. We also compared the effect of spikes on two types of hippcampal cells; place cells that discharge rapidly only when the rat's head is in a specific part of the environment, the so-called firing field, and interneurons, which are a main source of inhibition in the hippocampus.

RESULTS

IS were associated with a decreased likelihood of AP compared with IS-free portions of the record. Compared to pre-IS baseline, IS were followed by significant decreases in CA1 APs for periods up to 2 s following the IS in both models. When occurring in flurries, IS were associated with a pronounced decrease in APs. The response to IS was cell-dependent; IS resulted in decreases in AP firing after the IS in interneurons but not place cells.

CONCLUSIONS

This study demonstrates that IS have substantial effects on cellular firing in the hippocampus and that these effects last far longer than the spike and slow wave. Furthermore, the effect of IS on cellular firing was cell specific, affecting interneurons more than place cells. These findings suggest that IS may contribute to seizure-induced cognitive impairment by altering AP firing in a cell-specific manner.

Seizures and Antiepileptic Drugs: Does Exposure Alter Normal Brain Development?

Seizures and antiepileptic drugs (AEDs) affect brain development and have long-term neurological consequences. The specific molecular and cellular changes, the precise timing of their influence during brain development, and the full extent of the long-term consequences of seizures and AEDs exposure have not been established. This review critically assesses both the basic and clinical science literature on the effects of seizures and AEDs on the developing brain and finds that evidence exists to support the hypothesis that both seizures and antiepileptic drugs influence a variety of biological process, at specific times during development, which alter long-term cognition and epilepsy susceptibility. More research, both clinical and experimental, is needed before changes in current clinical practice, based on the scientific data, can be recommended.

Representing episodes in the mammalian brain

Memory lets the past inform the present so that we can attain future goals. In many species, these abilities require the hippocampus. Recent experiments, in which memory demand was varied while overt behavior and the environment were kept constant, have revealed firing patterns of hippocampal neurons that corresponded with memory demands and predicted performance. Although the active population appeared to be 'place cells' that signalled location, it actually included cells the activity patterns of which distinguished the recent or pending history of behavior during identical actions that occurred in the same place. Different populations of hippocampal cells fired as a rat walked along the same spatial path on the way to different goals, and coded past, present and pending events. Other experiments provide converging data that neuronal activity is modulated by goal-directed behavioral episodes. Together, these firing patterns suggest a testable mechanism of episodic memory coding: that hippocampal dynamics encode a temporally extended, hierarchically organized representation of goal-directed behavior.

Amelioration of water maze performance deficits by topiramate applied during pilocarpine-induced status epilepticus is negatively dose-dependent

Temporal lobe epilepsy is characterized by a progressive loss of memory capacities, due to sclerosis and functional impairment of mesiotemporal brain areas. We have shown recently that topiramate (TPM) dose-dependently protects hippocampal CA1 and CA3 neurons during initial status epilepticus in the rat pilocarpine model of temporal lobe epilepsy by inhibition of mitochondrial transition pore opening. In the present study, in order to evaluate possible positive effects of the treatment on learning and memory, we investigated water maze performance of rats receiving different dosages of TPM (20 and 100 mg/kg) after 40 min and 4 mg/kg diazepam after 160 min of pilocarpine-induced status epilepticus in relation to performance of animals receiving 4 mg/kg diazepam after 40 min of SE, and to performance of sham-treated control animals. Unexpectedly, 20 but not 100 mg/kg TPM significantly extenuated short-term memory deficits. While neuroprotective effects of TPM were observed in hippocampal CA subfields of animals treated with 100 mg/kg TPM, cell loss in rats treated with 20 mg/kg TPM was indistinguishable from animals receiving diazepam only. The present results indicate a negative dose-dependency of memory-saving effects of TPM applied during status epilepticus apparently dissociated from hippocampal neuroprotection.

Effect of levetiracetam on visual-spatial memory following status epilepticus

Status epilepticus (SE) is often followed by severe cognitive impairment, including memory impairment. Previous studies have shown that SE is associated with impairment of single cells in the hippocampus that fire action potentials when the animal is in a specific location in space, the so-called place cells, and that place cell function correlates well with performance in tasks of visual-spatial memory. Place cell patterns therefore appear to be an excellent measure of spatial memory and may serve as a tool to assess seizure-induced impairment in memory. In this study we determined the relationship between visual-spatial memory and place cell function following SE. In addition, we determined if levetiracetam (LEV), an antiepileptic drug with a novel mechanism of action, can improve cognitive function and place cell firing patterns when administered following SE. SE was induced in adult male rats which were then randomized to post-SE treatment with LEV or normal saline (NS) treatment for 14 days. Non-SE control rats also were randomized to LEV or NS. Following discontinuation of LEV rats were tested for visual-spatial memory in the Morris water-maze and then underwent unit recording in the CA1 region of the hippocampus. Brains were then evaluated for cell loss and mossy fiber sprouting. SE was associated with severely impaired performance in the water-maze with SE rats demonstrating no learning over four days of testing. Paralleling this memory deficit was a marked disturbance in firing patterns of pyramidal neurons in CA1. Non-SE rats learned quickly over four days of water-maze testing and had normal pyramidal cell firing patterns. LEV had no major effects on water-maze performance or place cell function. Histopathological examination of the brains showed severe cell loss in CA1 in all of the SE rats with lesser degrees of injury in CA3 and the hilus. LEV treatment resulted in less histological damage in the hippocampus but had no effect on visual-spatial function or place cell physiology in either control or SE rats.

Role of interictal epileptiform abnormalities in cognitive impairment

The epileptic encephalopathies are conditions in which neurological deterioration is attributable entirely or partly to epileptic activity and is due to very frequent or severe seizures or severely abnormal electroencephalograms (EEGs), or both. Evidence for the concept that seizures or the abnormal EEGs are responsible for the cognitive deterioration is the observation that patients can improve dramatically when therapy eliminates or reduces seizure frequency and improves or normalizes the EEG. For example, children with the syndrome of continuous spike-wave of sleep (CSWS) have electrical status epilepticus during sleep (ESES) and cognitive regression. Although seizures often occur in the disorder, there are indications that the EEG abnormalities are responsible for the cognitive regression. Interictal spikes, which correspond to a large intracellular depolarization with evoked action potentials, in many ways mimic a "miniseizure." Interictal spikes can result in transitory cognitive impairment with the type of deficit dependent on where in the cortex the spike arises. We suggest that interictal spikes, particularly if frequent and widespread, can impair cognitive abilities, through interference with waking learning and memory, and memory consolidation during sleep.

Effects of seizures on brain development: lessons from the laboratory

Both clinical and laboratory studies demonstrate that seizures early in life can result in permanent behavioral abnormalities and enhance epileptogenicity. In experimental rodent models, the consequences of seizures are dependent upon age, etiology, seizure duration, and frequency. Recurrent seizures in immature rats result in long-term adverse effects on learning and memory. These behavioral changes are paralleled by changes in brain connectivity, dendritic morphology, excitatory and inhibitory receptor subunits, ion channels, and neurogenesis. These changes can occur in the absence of cell loss. Although impaired cognitive function and brain changes have been well documented after early onset seizures, the mechanisms of seizure-induced injury remain unclear. Recent studies have demonstrated abnormalities in single cell function that parallel behavioral changes.

Volumetric Magnetic Resonance Imaging of Functionally Relevant Structural Alterations in Chronic Epilepsy after Pilocarpine-induced Status Epilepticus in Rats

PURPOSE

After pilocarpine-induced epilepsy in rats, volumetric magnetic resonance imaging (MRI) reveals significant morphologic changes in functionally relevant structures of the brain. To relate structural changes to functional alteration, we studied the correlation of regional brain atrophy (e.g., of the hippocampus) with lesion-induced learning deficits in the Morris water maze.

METHODS

MRI experiments were performed on an MR scanner at 4.7 Tesla. For volumetric analysis, various cerebral structures were segmented in horizontal and coronal T(2)-weighted MR images. Before the MRI investigations, animals were trained for 10 days in a Morris water maze.

RESULTS

Volumetric MRI revealed a significant loss in hippocampal size in both the dorsal and ventral parts, correlated with an increase in ventricular size. Furthermore, significant losses were found in the relative size of thalamus, putamen, cortex, and the combined areas of perirhinal, entorhinal, and piriform cortices adjacent to the hippocampus. A significant correlation of learning performance in the Morris water maze with the relative hippocampal area and not with other areas tested was observed in pilocarpine-treated animals.

CONCLUSIONS

The data provide a quantitative analysis of functionally relevant structural alterations in rats with chronic epilepsy. Water maze performance of pilocarpine-treated animals correlates with the degree of hippocampal but not with the degree of cortical damage, demonstrating the potential of this method for the investigation of cognitive impairments in relation to cerebral changes. In addition, the data point to an important role of even the residual hippocampus in memory formation.

Androgens in the hippocampus can alter, and be altered by, ictal activity

Steroid hormones, such as androgens, can modulate seizure processes. This review summarizes prior research and presents new data that support the role of androgens in modulating seizure processes. Testosterone, the primary endogenous androgen, has antiseizure effects in people and in animal models of epilepsy. Furthermore, testosterone's antiseizure effects may involve actions of its 5alpha-reduced metabolite and neuroactive steroid, 5alpha-androstane-3alpha,17beta-diol (3alpha-diol). The hippocampus is a target for androgen action and is involved in many types of seizure disorder. Data suggest that actions of androgens in the hippocampus may be important for androgens' antiseizure effects. Interestingly, there may also be a reciprocal relationship between androgens and seizures. Ictal activity can alter the gonadal responsiveness of people with epilepsy and in animal models of seizure disorder. Thus, this paper will review data in support of androgens' antiseizure effects. Further understanding of androgens' role in seizure processes is important for potential therapeutic effects.

Cognitive impairment following status epilepticus and recurrent seizures during early development: support for the "two-hit hypothesis"

Prolonged seizures in immature rats result in minimal behavioral consequences when the animals are studied later in life. Likewise, early-onset seizures are associated with minimal morphological changes. However, it is known that seizures early in life result in changes in the brain that make it more vulnerable to subsequent seizure-induced injury (the so-called two-hit hypothesis). Whether this heightened vulnerability occurs immediately after the first seizure is not known. In this study, immature rats were exposed to status epilepticus (SE) followed by a series of 25 flurothyl-induced seizures, SE alone, 25 flurothyl-induced seizures alone, or no seizures. Rats exposed to SE and flurothyl seizures performed significantly poorer in the water maze 2 weeks following the last seizure compared with the other groups. No histological lesions were seen in any of the four groups. This study suggests that SE renders the immature brain vulnerable to further seizure-induced injury and this enhanced vulnerability occurs very quickly after the SE.

Effect of food deprivation during early development on cognition and neurogenesis in the rat

Food deprivation has been recognized as having pronounced beneficial effects in adult animals, increasing longevity, reducing seizure susceptibility, and enhancing resistance to neurotoxins. It is not known whether food deprivation in developing animals is neuroprotective or harmful. To evaluate the effects of food deprivation on brain development, we evaluated visual-spatial learning and memory and neurogenesis in the dentate gyrus of the hippocampus in food-deprived (FD) and well-fed (WF) rats. To induce food deprivation, pups were removed from their dams for 12 hours per day from Postnatal Day (P) 2 to P19. FD and WF rat pups were then subjected to status epilepticus (SE) induced by lithium-pilocarpine at P20. After SE, neurogenesis was measured, while in another group of P38 rats, learning and memory were evaluated using the Morris water maze. Food deprivation was found to reduce neurogenesis when assessed after the period of food deprivation. Although SE reduced neurogenesis in the WF animals, it had little effect additional to food deprivation on neurogenesis in the FD rats. Compared with the WF group, FD rats had a mild impairment in memory in the water maze testing after SE. Our study demonstrates that food deprivation during the neonatal period in rats is associated with a decrease in neurogenesis and mild impairment of visual-spatial memory. Although SE decreased neurogenesis in the WF group, in FD animals, SE did not reduce neurogenesis more than what was seen with food deprivation alone. Our results suggest that although food deprivation during early development reduces dentate gyrus neurogenesis, the reduced neurogenesis is not a major factor in cognitive impairment after SE in FD rats.

Effects of early seizures on later behavior and epileptogenicity

Both clinical and laboratory studies demonstrate that seizures early in life can result in permanent behavioral abnormalities and enhance epileptogenicity. Understanding the critical periods of vulnerability of the developing nervous system to seizure-induced changes may provide insights into parallel or divergent processes in the development of autism. In experimental rodent models, the consequences of seizures are dependent on age, etiology, seizure duration, and frequency. Recurring seizures in immature rats result in long-term adverse effects on learning and memory. These behavioral changes are paralleled by changes in brain connectivity, changes in excitatory neurotransmitter receptor distribution, and decreased neurogenesis. These changes occur in the absence of cell loss. Although impaired cognitive function and brain changes have been well-documented following early-onset seizures, the mechanisms of seizure-induced dysfunction remain unclear.