Decreased anticonvulsant activity of carbamazepine in 6-hydroxydopamine-treated rats

Mechanisms regulating GABAergic inhibitory transmission in the basolateral amygdala: implications for epilepsy and anxiety disorders

The amygdala, a temporal lobe structure that is part of the limbic system, has long been recognized for its central role in emotions and emotional behavior. Pathophysiological alterations in neuronal excitability in the amygdala are characteristic features of certain psychiatric illnesses, such as anxiety disorders and depressive disorders. Furthermore, neuronal excitability in the amygdala, and, in particular, excitability of the basolateral nucleus of the amygdala (BLA) plays a pivotal role in the pathogenesis and symptomatology of temporal lobe epilepsy. Here, we describe two recently discovered mechanisms regulating neuronal excitability in the BLA, by modulating GABAergic inhibitory transmission. One of these mechanisms involves the regulation of GABA release via kainate receptors containing the GluR5 subunit (GluR5KRs). In the rat BLA, GluR5KRs are present on both somatodendritic regions and presynaptic terminals of GABAergic interneurons, and regulate GABA release in an agonist concentration-dependent, bidirectional manner. The relevance of the GluR5KR function to epilepsy is suggested by the findings that GluR5KR agonists can induce epileptic activity, whereas GluR5KR antagonists can prevent it. Further support for an important role of GluR5KRs in epilepsy comes from the findings that antagonism of GluR5KRs is a primary mechanism underlying the antiepileptic properties of the anticonvulsant topiramate. Another mechanism regulating neuronal excitability in the BLA by modulating GABAergic synaptic transmission is the facilitation of GABA release via presynaptic alpha1A adrenergic receptors. This mechanism may significantly underlie the antiepileptic properties of norepinephrine. Notably, the alpha1A adrenoceptor-mediated facilitation of GABA release is severely impaired by stress. This stress-induced impairment in the noradrenergic facilitation of GABA release in the BLA may underlie the hyperexcitability of the amygdala in certain stress-related affective disorders, and may explain the stress-induced exacerbation of seizure activity in epileptic patients.

Reduced anticonvulsant efficacy of valproic acid in dopamine β-hydroxylase knockout mice

Valproic acid (VPA) is a widely used treatment for both epilepsy and bipolar disorders, although its therapeutic mechanism of action is not fully understood. Because norepinephrine (NE) is implicated in seizure susceptibility and affective disorders, and given previous findings indicating that VPA can act on the NE system, it is possible that NE may mediate some of the therapeutic actions of VPA. To test this hypothesis, we measured flurothyl-induced seizure susceptibility and severity parameters after both acute and chronic VPA treatments in dopamine beta-hydroxylase knockout (Dbh -/-) mice that lack NE. We found that the protective effects of acute VPA on seizure susceptibility, as measured by latency to first myoclonic jerk, were attenuated in Dbh -/- mice. Further, while acute VPA reduced the number of control mice that progressed to tonic extension, VPA did not reduce seizure severity in Dbh -/- mice. The carryover anticonvulsant effects following cessation of chronic VPA treatment were similar in both genotypes. Therefore, we conclude that NE is involved in some of the anticonvulsant effects of VPA, especially the effect of acute VPA on seizure severity.

Review of the pharmacological and clinical profile of rimcazole

Rimcazole is a carbazole derivative that acts in part as a sigma receptor antagonist. Wellcome Research Laboratories introduced this compound during the 1980s when it was hypothesized to be a novel antipsychotic with an improved side effect profile. However, subsequent clinical trials demonstrated that rimcazole lacked efficacy in schizophrenic patients and it is now primarily used as an experimental tool. In addition to its actions as a sigma receptor antagonist, rimcazole also has high affinity for dopamine transporters, and in recent years it has served as a lead compound for the development of novel dopamine transporter ligands. Although rimcazole cannot be considered a selective ligand for sigma receptors, the recent development of other selective agonists and antagonists for sigma receptors have aided in clarifying the involvement of these receptors in the actions of rimcazole. Many of the physiological and behavioral effects of rimcazole can in fact be ascribed to its action as a sigma receptor antagonist, although there are exceptions. Rimcazole is likely to have a continued role in elucidating sigma receptor function in either in vitro or in vivo systems where sigma receptor-mediated effects can be studied independently of the influence of dopamine and serotonin transporters.

Norepinephrine is required for the anticonvulsant effect of the ketogenic diet

Ketogenic diet (KD) is a high fat, low carbohydrate diet used to treat children with epilepsy that are refractory to conventional antiepileptic drugs (AEDs). The anticonvulsant mechanism of the KD is unknown. To determine if the noradrenergic system has a role in mediating the anticonvulsant action of the KD, dopamine beta-hydroxylase knockout (Dbh -/-) mice that lack norepinephrine (NE) and Dbh +/- littermates that have normal NE content were fed either a standard rodent chow or the KD. When exposed to the convulsant flurothyl, Dbh +/- mice fed the KD had significantly longer latencies to myoclonic jerk (MJ) and generalized clonic-tonic (CT) seizures than Dbh +/- mice fed normal chow. In contrast, Dbh -/- mice fed the KD had seizure latencies to both MJ and CT comparable to Dbh -/- mice fed normal chow. These results suggest that an intact, functional noradrenergic nervous system is required for the KD to exert an anticonvulsant effect.

Alterations in monoamine levels in discrete regions of rat brain after chronic administration of carbamazepine

Carbamazepine (25 mg/kg body weight) was administered intraperitoneally to adult male Wistar rats for 45 days and norepinephrine (NE), dopamine (DA) and serotonin (5-HT) levels were simultaneously assayed in discrete brain regions by high performance liquid chromatographic (HPLC) method. Experimental rats displayed no behavioral abnormalities. Body and brain weights were not significantly different from control group of rats. After exposure it was observed that norepinephrine levels were elevated in motor cortex (P < 0.01) and cerebellum (P < 0.05), while dopamine levels were decreased in these two regions (P < 0.001, P < 0.05). However, dopamine levels were increased in hippocampus (P < 0.01). Serotonin levels were significantly decreased in motor cortex (P < 0.001) and hypothalamus (P < 0.001) but increased in striatum-accumbens (P < 0.001) and brainstem (P < 0.001). These results suggest that carbamazepine may mediate its anticonvulsant effect by differential alterations of monoamine levels in discrete brain regions particularly in motor cortex and cerebellum.

Immunomodulating properties of carbamazepine in mice

The protective effects of carbamazepine (CBZ) were studied in mice inoculated with Lewis Lung Carcinoma (3LL), Madison Lung Carcinoma (M109), L5178Y lymphoma, L1210 leukaemia and Candida albicans. There was no significant increase in survival time of mice treated with CBZ. However, CBZ, as well as its metabolite CBZ 10-11 epoxide (CBZ 10-11 EPOX), showed a significant increase in NK-cell activity. CBZ also produced a significant increase of phagocytosis and killing properties of PMNs. There was no significant difference in the stimulation of splenic lymphocyte blastogenesis by different concentrations of phytohaemagglutinina (PHA), observed between the controls and CBZ treated mice. The results demonstrate that the effect of chronic treatment with CBZ on the immune response is a complex phenomenon which remains a challenge for future research.

Administration of carbamazepine in the nucleus of the solitary tract inhibits the antihypertensive effect of clonidine

The effects of carbamazepine administration into the nucleus tractus solitarii (NTS) on central alpha 2-adrenergic cardiovascular function were studied in normotensive Wistar Kyoto (WKY) and spontaneously hypertensive rats (SHR). Stereotaxic microinjections of carbamazepine (288 ng/60 nl) into the NTS of SHR transiently increased blood pressure, heart rate, and renal sympathetic nerve activity. These effects were followed by a modest depressor and bradycardic effect, with no change in sympathetic nerve activity. In addition, previous intra-NTS administration of carbamazepine attenuated the antihypertensive effect of the centrally acting alpha 2-adrenoceptor agonist, clonidine. Similar carbamazepine effects were observed in the WKY rats. These results suggest that some of the cardiovascular changes observed during carbamazepine treatment involve antagonism of central noradrenergic mechanisms.

Growth hormone response to diazepam, clonidine and glucagon in patients with epilepsy

The differing actions of phenytoin, carbamazepine and sodium valproate on growth hormone release were studied in 20 patients with recently diagnosed epilepsy using diazepam, clonidine and glucagon as stimulatory tests of growth hormone response. The results are compared with the growth hormone response obtained pre treatment, and those from 20 control patients and 11 patients with chronic treated epilepsy. There was a reduction in growth hormone response to diazepam in both treated and untreated patients with epilepsy compared to controls. Treatment with phenytoin resulted in a significant increase in growth hormone release after diazepam and glucagon, whilst sodium valproate reduced the growth hormone response to diazepam.

A possible role for spinal noradrenaline in the mechanisms of 6-hydroxydopamine against pentylenetetrazol induced convulsions in rats

The threshold of the generalized clonic convulsions induced by intravenous infusion of pentylenetetrazol (PTZ) was significantly increased by the intraperitoneal administration of noradrenaline (NA) neurotoxin, 6-hydroxydopamine, which produced no changes in the levels of catecholamines in discrete areas of rat brain, but the effect was accompanied by spinal depletion of NA. Moreover, the anticonvulsant effects of phenobarbitone (PB) and diphenylhydantoin (DPH) against PTZ convulsions were also significantly increased in the animals pretreated with 6-OHDA. These results suggest that the observed elevation of PTZ convulsive threshold and the potentiation of anticonvulsant activity of PB and DPH in 6-OHDA treated rats were possibly mediated through spinal cord depletion of NA.

Effect of carbamazepine on dopamine release and reuptake in rat striatal slices

Carbamazepine has been shown to enhance dopaminergic agonist behavioral effects, but not to displace [3H]spiroperidol binding. To verify if carbamazepine acts presynaptically on dopaminergic neurons, reuptake and release of [3H]dopamine were measured in rat striatal slices in vitro. It was observed that carbamazepine blocked 20% of the reuptake of [3H]dopamine, while cocaine blocked 82% of the reuptake, compared with control. Carbamazepine released 62% and tyramine released 92% of the accumulated [3H]dopamine, compared with control. It was concluded that carbamazepine acts presynaptically on striatal neurons, mainly through enhancement of dopamine release. This finding can be related to some behavioral effects described for carbamazepine; however, the importance of its effects in epileptic and manic-depressive patients remains to be clarified.

Alcohol withdrawal and carbamazepine

The use of pharmacologic intervention in the management of alcohol withdrawal syndrome is briefly presented. The use of carbamazepine, a tricyclic anticonvulsant with clinical efficacy in depressive illness, in alcohol withdrawal treatment is reviewed. A comparative analysis between carbamazepine and major drugs used in alcohol withdrawal syndrome is made. This includes the evaluation of both clinical advantages and disadvantages in addition to identification of drug adverse reaction and interaction with alcohol. The mechanism of action of carbamazepine is also examined. Carbamazepine appears to possess a useful pharmacotherapeutic potential in the management of acute alcohol withdrawal syndrome, and its use in long-term treatment is suggested.

Effects of carbamazepine on noradrenergic mechanisms in affectively ill patients

Noradrenergic mechanisms have been postulated to account for the anticonvulsant and psychotropic effects of carbamazepine. In order to assess this possibility in man, cerebrospinal fluid (CSF) was obtained from affectively ill patients before and during treatment with carbamazepine (average duration 29 days) at doses averaging 860 mg/day, achieving blood levels of 8.86 micrograms/ml. Neither plasma nor CSF norepinephrine (NE) nor CSF 3-methoxy-4-hydroxy-phenylglycol (MHPG) was significantly altered by carbamazepine. Baseline medication-free values in 21 depressed patients were not predictive of the degree of subsequent clinical antidepressant response. CSF NE decreased in four manic patients treated with carbamazepine. The many effects of carbamazepine on noradrenergic mechanisms in animals are discussed in relationship to these first studies of carbamazepine in man.

The action of anticonvulsant drugs on the firing of locus coeruleus neurons: selective, activating effect of carbamazepine

The action of various doses of intraperitoneally administered carbamazepine, ethosuximide, Na-valproate, phenobarbital and diphenylhydantoin on the neuronal firing rate of presumed noradrenergic neurons of the locus coeruleus was investigated in the anaesthetized rat. Carbamazepine was the only compound which produced a statistically significant, dose-dependent activation of these neurons. The other anticonvulsant drugs caused a small but non significant reduction in locus coeruleus cell firing. It is concluded that this brain nucleus is not a main target of anticonvulsant drugs.

Biochemical effects of carbamazepine: relationship to its mechanisms of action in affective illness

Carbamazepine has a unique spectrum of clinical efficacy in paroxysmal pain syndromes and epilepsy, as well as in affective illness. Evidence of its therapeutic effects in lithium-resistant manic-depressive illness and schizoaffective illness is reviewed. The biochemical effects of carbamazepine as they might be related to either its anticonvulsant or psychotropic properties are presented and discussed. Carbamazepine alters classical neurotransmitter and second messenger systems, as well as a variety of neuropeptides which could relate to mechanisms of action or side effects. Comparison and contrast of the biological effects of carbamazepine with classical treatment agents, such as lithium carbonate, tricyclic antidepressants, and neuroleptics may help elucidate mechanisms underlying the pathophysiology of the mood disorders.

Handling-induced seizures and rotational behavior in th Mongolian gerbil

The aim of this report was to examine the relationship between sensory-induced seizures, cerebral laterality (as measured by rotation) and nigrostriatal asymmetry in Mongolian gerbils. Seizure resistant gerbils made proportionally more spontaneous turns to be preferred direction than sensitive animals. Three prototypical antiepileptic drugs strongly elicited rotational behavior (carbamazepine (10-20 mg/kg), diazepam (16 mg/kg) and pentobarbital (40 mg/kg)) and two others (phenobarbital 20-40 mg/kg) and ethosuximide (500 mg/kg)) also appeared to potentiate rotation; only diphenylhydantoin and trimethadione were effective. Two dopaminergic agonists, amphetamine (4 mg/kg) and apomorphine (16 mg/kg) enhanced rotation at anticonvulsant doses while the dopaminergic antagonist haloperidol reduced rotational behavior at a dose (1 mg/kg) which exacerbate seizure severity. Finally, surgical induction of nigrostriatal asymmetry by means of unilateral electrolytic striatal lesions reduced seizure severity; sham and bilateral striatal lesions had no significant effects on seizures. These results suggest that seizure activity and rotational behavior are inversely related and, furthermore, that the link between these two behaviors may be the asymmetry between nigrostriatal dopaminergic systems.

Catecholamines and convulsions

Severe depletion of brain noradrenaline and separately of brain dopamine was induced in rats by intracerebral injection of the selective neurotoxin 6-hydroxydopamine, and the susceptibility of the treated animals to various seizure-inducing manipulations was examined. A significant potentiation of the seizures induced both by Metrazol and by electroconvulsive shock was found in animals depleted of brain noradrenaline, but no alteration was seen after depletion of brain dopamine on either measure. The catecholaminergic drug cocaine also induced seizures, but these were found not to depend on either brain noradrenaline or dopamine as they continued to occur in the virtual absence of either catecholamine. It is concluded that cocaine induces seizures by a non-specific toxic mechanism and that noradrenaline, but not dopamine, is involved in reducing the suceptibility of the central nervous system to the several distinct forms of seizure induction examined.

Inhibition of the action of anticonvulsants by lithium treatment

The present study demonstrates that the effectiveness of anticonvulsants significantly decreases following lithium treatment (3 doses of 50 mg/kg of LiCl given every 12 hr). The anticonvulsant action of phenytoin, phenobarbital and of 3 carbonic anhydrase inhibitors: methazolamide, acetazolamide, ethoxzolamide, was assessed in rats subjected to maximal electroshock. In a chronic study on tolerance development to the anticonvulsant action of acetazolamide, lithium treatment (10 mg/kg per day) has been shown to inhibit gradually the action of acetazolamide. These results are consistent with the hypothesis that norepinephrine and dopamine are involved in the action of anticonvulsants.

Depletion of brain noradrenaline, but not dopamine, by intracerebral 6-hydroxydopamine potentiates convulsions induced by electroshock

Intracerebral injection in rats of 4 microgram of the catecholamine neurotoxin 6-hydroxydopamine was used to deplete forebrain noradrenaline to less than 10% of control values and separately to deplete brain dopamine to less than 15% of control. The susceptibility of these animals to electroconvulsive shock-induced convulsions was examined, and a significant potentiation of the response was seen in the rats depleted of noradrenaline but not in those depleted of dopamine. The duration of the convulsion was significantly increased as a result of loss of forebrain noradrenaline.

Evidence against serotonin involvement in the tonic component of electrically induced convulsions and in carbamazepine anticonvulsant activity

Intraventricular injection of 5,7-dihydroxytryptamine, selective destruction of descending serotoninergic neurons by 5,6-dihydroxytryptamine or electrolytic and chemical lesions of the nucleus raphe dorsalis did not affect the electroconvulsive threshold in rats. No effect was observed after the systemic administration of drugs known to increase central serotonin transmission, such as quipazine, m-chlorophenylpiperazine, and moderate doses of d-fenfluramine, whereas p-chlorophenylalanine, an inhibitor of serotonin synthesis, decreased seizure susceptibility. The anticonvulsant activity of carbamazepine was not modified in animals with the same experimental lesions. The results, in relation to the high selectivity of the experimental procedures employed to deplete brain and spinal cord serotonin, do not bear out any involvement of serotonin in the tonic component of electrically induced convulsions or in the action of carbamazepine.