Ketamine-induced changes in kindled amygdaloid seizures

The NMDA receptor complex as a therapeutic target in epilepsy: a review

A substantial amount of research has shown that N-methyl-D-aspartate receptors (NMDARs) may play a key role in the pathophysiology of several neurological diseases, including epilepsy. Animal models of epilepsy and clinical studies demonstrate that NMDAR activity and expression can be altered in association with epilepsy and particularly in some specific seizure types. NMDAR antagonists have been shown to have antiepileptic effects in both clinical and preclinical studies. There is some evidence that conventional antiepileptic drugs may also affect NMDAR function. In this review, we describe the evidence for the involvement of NMDARs in the pathophysiology of epilepsy and provide an overview of NMDAR antagonists that have been investigated in clinical trials and animal models of epilepsy.

Ketamine increases human motor cortex excitability to transcranial magnetic stimulation

Subanaesthetic doses of the N-methyl-D-aspartate (NMDA) antagonist ketamine have been shown to determine a dual modulating effect on glutamatergic transmission in experimental animals, blocking NMDA receptor activity and enhancing non-NMDA transmission through an increase in the release of endogenous glutamate. Little is known about the effects of ketamine on the excitability of the human central nervous system. The effects of subanaesthetic, graded incremental doses of ketamine (0.01, 0.02 and 0.04 mg kg-1 min-1, I.V.) on the excitability of cortical networks of the human motor cortex were examined with a range of transcranial magnetic and electric stimulation protocols in seven normal subjects. Administration of ketamine at increasing doses produced a progressive reduction in the mean resting motor threshold (RMT) (F(3, 18) = 22.33, P < 0.001) and active motor threshold (AMT) (F(3, 18) = 12.17, P < 0.001). Before ketamine administration, mean RMT +/- S.D. was 49 +/- 3.3 % of maximum stimulator output and at the highest infusion level it was 42.6 +/- 2.6 % (P < 0.001). Before ketamine administration, AMT +/- S.D. was 38 +/- 3.3 % of maximum stimulator output and at the highest infusion level it was 33 +/- 4.4 % (P < 0.002). Ketamine also led to an increase in the amplitude of EMG responses evoked by magnetic stimulation at rest; this increase was a function of ketamine dosage (F(3, 18) = 5.29, P = 0.009). In contrast to responses evoked by magnetic stimulation, responses evoked by electric stimulation were not modified by ketamine. The differential effect of ketamine on responses evoked by magnetic and electric stimulation demonstrates that subanaesthetic doses of ketamine enhance the recruitment of excitatory cortical networks in motor cortex. Transcranial magnetic stimulation produces a high-frequency repetitive discharge of pyramidal neurones and for this reason probably depends mostly on short-lasting AMPA transmission. An increase in this transmission might facilitate the repetitive discharge of pyramidal cells after transcranial magnetic stimulation which, in turn, results in larger motor responses and lower thresholds. We suggest that the enhancement of human motor cortex excitability to transcranial magnetic stimulation is the effect of an increase in glutamatergic transmission at non-NMDA receptors similar to that described in experimental studies.

Effects of acute treatment and long-term treatment with MK-801 against amygdaloid kindled seizures in rats

Effects of both acute and long-term treatments with a non-competitive NMDA-antagonist, MK-801, were studied in rats in order to investigate whether NMDA receptors would be involved in the maintenance of kindling. Intraperitoneally administered MK-801 at doses of 0.5, 1.0 and 2.0 mg/kg inhibited fully amygdaloid kindled seizures (stage 5) behaviorally and significantly reduced the duration of after discharge and postictal spikes in a dose-dependent manner. Long-term (28 days) administration of MK-801 at three dosages neither abolished behavioral kindled seizures nor significantly altered generalized seizure thresholds. However the after discharge duration and postictal spikes were significantly reduced in rats treated with MK-801 at doses of 0.5 and 1.0 mg/kg, while no significant alterations were observed in rats treated with saline or MK-801 at a dose of 2.0 mg/kg. Acute effects of MK-801 suggested that NMDA receptors were involved in the maintenance of kindling. On the other hand, long-term treatments with MK-801 remained to show such an unequivocal effect.

NMDA receptor dependence of kindling and mossy fiber sprouting: evidence that the NMDA receptor regulates patterning of hippocampal circuits in the adult brain

The NMDA receptor plays an important role in patterning neural connectivity in the developing brain. In the adult brain, repeated kindling stimulation of limbic pathways increases the NMDA-dependent component of synaptic transmission in granule cells of the dentate gyrus (DG) and also induces sprouting of the mossy fiber axons of granule cells that reorganizes synaptic connections in the DG. Because the NMDA antagonist MK801 impedes the progression of kindling, it was of interest to determine whether MK801 also modified mossy fiber sprouting. Low doses of MK801, which had no antiseizure effect, impaired the progression of kindling and development of mossy fiber sprouting during the initial and also more advanced stages of kindling. These observations demonstrate that the NMDA receptor is a component of a molecular pathway that influences the progression of kindling and mossy fiber sprouting and suggest that NMDA-dependent gene expression may play a role in the development of long-term structural and functional alterations induced by seizures in hippocampal circuitry. The NMDA receptor appears to play a continuing role in modifying the organization and patterns of connectivity in hippocampal circuits of the adult brain.

NMDA antagonists: antiepileptic-neuroprotective drugs with diversified neuropharmacological profiles

In conclusion, NMDA antagonists as anticonvulsants are especially active in preventing the generalization of the behavioural and electrical seizures and display a typical spectrum of in vitro antiepileptiform activities. In addition, based on in vitro and in vivo limbic kindled studies, the drugs should be regarded more as an antiepileptiform than as an anticonvulsant drugs. As neuroprotective drugs, NMDA antagonists are effective against many types of neuronal injury and show a window of activity which does not exceed 1-2 h, thus suggesting an influence of NMDA receptors in the 'early' or 'acute' mechanisms of brain damage. Among NMDA antagonists, glycine antagonists or the morphinans dextromethorphan and dextrorphan showed a spectrum of antiepileptiform and neuroprotective activities broader than other NMDA antagonists. The primary pharmacological activities of NMDA antagonists are accompanied by some effects including perturbation of many sensory, psychological or motor processes. Typical behavioural and EEG changes were also induced by the drugs. In spite of the side-effects elicited by the drugs, differential effects detected among the various classes of NMDA antagonists (i.e. lack of induction of typical EEG-behavioural effects and of typical cortical neurotoxicity) might render some of these suitable for full clinical application as anticonvulsant-neuroprotective drugs.

Analyses of the molecular basis of kindling development

Kindling has become the most widely studied animal model of limbic epilepsy. Understanding the molecular basis of kindling development may provide novel therapeutic approaches to prevention of limbic epileptogenesis. I briefly describe the kindling model and outline the basis for my thinking that kindling represents a synaptic reorganization triggered by pathologic activity in the mature nervous system. The pathologic activity is postulated to evoke a cascade of gene expression driven, at least in part, by glutamate receptor activation. Evidence in support of this hypothesis is presented, as are future challenges that permit critical tests of these ideas.

Developmental changes of ketamine action against epileptic afterdischarges induced by hippocampal stimulation in rats

Action of ketamine (5-40 mg/kg) was tested against electrically induced hippocampal afterdischarges (four stimulations in one session; 8 Hz, 15 s) in rats 7, 12, 18, 25 and 90 days old. In control sessions, there was either stable afterdischarge (AD) duration and wet dog shakes (WDS) number or there was an increase in ADs' duration with repeated stimulations. Ketamine had dose-dependent and age-dependent effects. In 7-18-day-old rats, ketamine suppressed better WDS number than AD duration, with nearly absent action on AD duration in 18-day-old animals. Ketamine was equipotent for both phenomena in 25-day-old rats and, in contrast, it decreased more AD duration than WDS number in 90-day-old rats. The data suggest a differentiation induced by ketamine in the expression of motor and electrographic phenomena of the experimental seizures.

The effect of the non-NMDA receptor antagonist GYKI 52466 and NBQX and the competitive NMDA receptor antagonist D-CPPene on the development of amygdala kindling and on amygdala-kindled seizures

A competitive (NBQX) and a non-competitive (GYKI 52466) AMPA antagonist, and a competitive NMDA antagonist (D-CPPene) were tested against the development of kindling and against fully kindled seizures in amygdala-kindled rats. GYKI 52466, 10 mg/kg given i.p. 5 min prior to electrical stimulation in fully kindled animals, reduces both the cortical after-discharge duration and the behavioural seizure score. GYKI 52466, 20 mg/kg, reduces seizure score and after-discharge duration significantly (after 5-30 min) but the animals show severe motor side effects and an irregular cortical and hippocampal EEG. Administration of GYKI 52466, 10 mg/kg, prior to kindling stimulation on days 3-8, does not slow the development of kindling. NBQX, 20 mg/kg or 40 mg/kg i.p., 30 min prior to stimulation, significantly reduces the seizure score in fully kindled animals. NBQX 20 mg/kg i.p. has no effect on the development of kindling. D-CPPene, 8 mg/kg or 12 mg/kg, 120 min prior to stimulation reduces the behavioural seizure score in fully kindled animals. D-CPPene, 8 mg/kg on days 3-8, delays the development of kindling. NMDA receptors play a key role in the kindling process. Expression of kindled seizures involves non-NMDA and NMDA receptors.

Models of simple partial and absence seizures in freely moving rats: action of ketamine

The action of ketamine was studied in two models of seizures: a) bilateral neocortical discharges produced by topical application of pentylenetetrazol (model of simple partial seizures); and b) rhythmic spike-and-wave activity induced by systemic administration of pentylenetetrazol (model of absence seizures). Ketamine exerted biphasic effects. In the first model, the dose of 20 mg/kg ketamine significantly suppressed the ictal neocortical discharges (i.e., continuous spiking or ictal activity) accompanied by clonic motor seizures. However, at the dose of 40 mg/kg ketamine significantly accentuated the onset and increased the number of individual discharges (interictal spikes) in bilateral neocortical foci. In the model of rhythmic spike-and-wave activity, the lower dose of ketamine (20 mg/kg) decreased the number of rhythmic spike-and-wave episodes when compared to the higher dose (40 mg/kg) of ketamine, which increased the number of episodes. However, neither result differed significantly from control values. The present results suggest a dose-dependent action of ketamine: Lower doses (10 and 20 mg/kg in the rat) are able to suppress seizure activity, whereas a higher dose (40 mg/kg) potentiates the seizures. Moreover, the action of ketamine may be dependent upon the seizure model used. The study presents a new model of acute epileptic focus in freely moving rats.

Differential effects of kindled and electrically induced seizures on a glutamate receptor (GluR1) gene expression

To address the question of whether the mode of seizure induction contributes to the effects of seizures on glutamate receptor gene expression, we examined rat dorsal hippocampal slides by in situ hybridization after kindling by electrical stimulation of the amygdala, or after electrically induced tonic-clonic seizures. Levels of a glutamate receptor subtype (GluR1) mRNA were analyzed at three periods post kindled seizures and found to be decreased only in brains that were obtained 24 h after the last kindled seizure. This downregulation of GluR1 mRNA was transient and was observed only in animals that had behavioral manifestations after being electrically stimulated. It is probable that maintenance of the kindled state cannot be explained by a long-lasting change in GluR1 gene expression. Repeated electroshock-induced seizures increased GluR1 mRNA levels in the hippocampus. Our results show that mode of induction is an important determinant of the effects of seizures on the levels of expression of a glutamate receptor gene.

Effects of competitive and noncompetitive NMDA receptor antagonists on kindling and LTP

In the present study, comparative studies of the effects of competitive and noncompetitive antagonists of NMDA receptors (CPP, CGS19755 and MK-801) on two models of neuronal plasticity, kindling and long-term potentiation (LTP), were performed in rats. Systemic administration of CPP (5, 10 mg/kg), CGS19755 (5, 10 mg/kg) or MK-801 (1, 2 mg/kg) strongly retarded kindling development from the amygdala (AM), in which the early stage of kindled seizures and the growth of afterdischarges (ADs) recorded from the AM were significantly suppressed. After establishment of kindling, however, these compounds only reduced the previously AM-kindled seizure stage without shortening the AD duration. These NMDA receptor antagonists with the same dose sufficient for suppressing AM kindling almost completely blocked LTP of the synaptic component in the hippocampal dentate gyrus following high-frequency trains of the perforant path in urethane-anesthetized rats. These results further support the hypothesis that neuronal plasticity is induced by activation of the NMDA receptor complex and one of the basic neuronal mechanisms underlying kindling may be a long-lasting increase in synaptic transmission.

NMDA receptor antagonists inhibit kindling epileptogenesis and seizure expression in developing rats

N-Methyl-D-aspartate (NMDA) receptor antagonists inhibit both the kindling process and the expression of seizures in previously kindled adult rats. Experimental seizures are more readily produced in infant than adult rats, possibly related to a developmental predominance of NMDA receptor-mediated effects. If so, reduction of seizure susceptibility by NMDA receptor antagonists should be more dramatic in infant rats than in adults. We studied the effect of ketamine and MK-801 on kindling epileptogenesis and seizure expression in 15-day-old rats. Ketamine (5, 10, and 20 mg/kg) and MK-801 (0.033 and 0.1 mg/kg) both significantly increased the latency to stage 3 or 4 seizures in dose-dependent fashion. These results were similar to those found in adults but occurred at slightly lower doses. Ketamine 20 mg/kg and MK-801 0.33 mg/kg totally eliminated clinical seizure activity and nearly abolished afterdischarge in previously kindled infant rats, effects exceeding those reported in adults using doses up to 6 times as great. These results support the hypotheses that NMDA receptor-mediated neurotransmission plays an important role in seizure production and the increased seizure susceptibility in immature brain and raise the possibility that NMDA receptor antagonists could be useful antiepilepsy agents in young children.

The effect of the NMDA receptor antagonist, MK-801, on the course and outcome of kindling

A rapid kindling procedure was used to distinguish between the anticonvulsant activity of drugs and their ability to retard the kindling process. MK-801 is a specific ligand at the phencyclidine (PCP) recognition site, and acts as a noncompetitive antagonist of NMDA-type glutamate/aspartate receptors. Intraperitoneal injections of MK-801 (0.5-4.0 mg/kg IP) significantly reduced the cumulated effect of 12 2-hr kindling stimulations, as determined from behavioral measures of seizure activity in immediately ensuing 24-hr drug-free kindling sessions; however, the corresponding electrographic effects did not reach significance. MK-801 also showed significant anticonvulsant activity when injected in fully kindled rats. Higher doses tested were accompanied by locomotor and postural effects. The anticonvulsant benzodiazepine, clonazepam, formulated with a proprietary diluent (as Rivotril, Roche), injected in anticonvulsant doses during the first 12 kindling sessions (0.64 mg/kg IP, repeated after 9 hr) did not significantly affect the course of subsequent sessions of drug-free kindling. Systemic injections of kynurenic acid (300-600 mg/kg IP 4 hours), a nonspecific antagonist of glutamate receptors in vitro, were without significant anticonvulsant or antikindling activity. Activity of NMDA-sensitive glutamate/aspartate receptors associated with the PCP recognition site may induce lasting facilitation of neural transmission; this facilitation may be responsible for the remote propagation and progressive enhancement of seizure activity kindled in the amygdala. The facilitatory process appears to be antagonised by MK-801.

NMDA receptor activation mediates the loss of GABAergic inhibition induced by recurrent seizures

Previously we have shown that delivery of rapidly recurring hippocampal seizures (RRHS) to awake rats causes a rapid kindling and that RRHS in urethane-anesthetized rats leads to a progressive lengthening of afterdischarges and diminution of paired pulse inhibition. The present experiments examined the relationship between the changes in afterdischarge durations and inhibition. Pre-treatment before RRHS with the non-competitive NMDA receptor antagonists MK-801 and ketamine blocked afterdischarge lengthening. MK-801 also prevented RRHS-induced changes in paired pulse inhibition. For pharmacodynamic and pharmacokinetic reasons the ability of ketamine to counteract RRHS-induced changes of paired pulse inhibition was not examined. MK-801 also blocked the rightward shift of stimulus intensity vs. population spike curves which RRHS caused. We suggest that RRHS leads to an enduring diminution of GABAergic inhibition and that this accounts, at least in part, for the lengthening of afterdischarges seen with recurrent hippocampal seizures. In addition, NMDA receptor activation appears to play a role in this decrease of the potency of GABAergic inhibition. However, mechanisms which are not dependent on NMDA receptor activation also play a critical role in hippocampal epileptogenesis.

Biochemical evidence for enhanced sensitivity to N-methyl-D-aspartate in the hippocampal formation of kindled rats

The inhibitory effect of N-methyl-D-aspartate (NMDA) upon carbachol-stimulated phosphoinositide (PI) hydrolysis was studied in transverse hippocampal slices prepared from control and amygdaloid kindled rats. Kindling significantly increased the inhibitory effect of NMDA (10 microM) in slices prepared from animals 24 h after the last class 5 kindled seizure, resulting in a steepening of the dose-response curve for NMDA. The enhanced sensitivity to NMDA was long-lasting in that it was also present in slices prepared from animals sacrificed 28-35 days after the last class 5 seizure. The increased sensitivity to NMDA was selective in that inhibition of carbachol-stimulated PI hydrolysis by kainic acid or phorbol-12,13-diacetate was not different in control and kindled animals. Neither NMDA, kainic acid, phorbol ester nor carbachol alone had any significantly different effects in slices from kindled versus control animals. These data demonstrate a selective and enhanced sensitivity of the kindled hippocampus to NMDA. This enhanced sensitivity to the principal class of excitatory neurotransmitter may be one mechanism underlying the development and maintenance of kindled epilepsy.

NMDA antagonists differentiate epileptogenesis from seizure expression in an in vitro model

In an electrographic model of seizures in the hippocampal slice, both of the N-methyl-D-aspartate (NMDA) antagonists 2-amino-5-phosphonovaleric acid and 5-methyl-10,11-dihydro-5H-dibenzo(a,d)cyclohepten-5,10-imine maleate (MK-801) prevented the progressive development of seizures but did not block previously induced seizures. Thus, a process dependent on the NMDA receptor-ionophore complex establishes a long-lasting, seizure-prone state; thereafter the seizures depend on non-NMDA receptor-ionophore mechanisms. This suggests that there is an important distinction between epileptogenesis and seizure expression and between antiepileptogenic and anticonvulsant pharmacological agents.

The effect of MK-801 on kindled seizures: implications for use and limitations as an antiepileptic drug

MK-801 is a new drug that produces a noncompetitive blockade at the subclass of glutamate receptors activated by N-methyl-D-asparate (NMDA). The antiepileptic properties of MK-801 were studied using kindled seizures as a model of complex partial seizures with secondary generalization. A test protocol was employed that allowed: (1) examination of the efficacy of MK-801 against several parameters that gauge different aspects of epileptogenesis; (2) determination of the time-action profile of these effects; and (3) examination of the toxicity of MK-801 in animals experiencing seizures. The drug was found to be potent against the spread of seizures but less effective against parameters linked to partial seizures. At the higher doses of the drug required to truncate hippocampal afterdischarges, considerable neurotoxicity was encountered. In addition, the antiepileptic effects of MK-801 showed a use dependence so that, at a given time after the drug was administered, a greater suppression of seizures was noted if there had been preceding seizures in the presence of the drug than if there had not been. These findings indicate that there may be limitations to the clinical utility of MK-801 as an antiepileptic agent and that the drug may provide greatest benefit when used for the suppression of seizure generalization and when seizures are closely spaced.

The drug MK-801 attenuates the development, but not the expression, of long-term potentiation and stimulus train-induced bursting in hippocampal slices

Recent studies have demonstrated that (+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]cyclohepten-5,10-imine (MK-801), a use-dependent blocker of N-methyl-D-aspartate (NMDA)-activated membrane channels, attenuates the development of long-term potentiation in vitro and kindling in vivo. Both of these phenomena are manifestations of physiological plasticity related to behavioural states and the results of these studies add to the gathering evidence for the involvement of the NMDA receptor/channel system in such processes. In the present experiment, slices of hippocampus, prepared from rats, were electrically stimulated to produce either long-term potentiation of the CA1 population spike or stimulus train-induced epileptiform bursting in area CA3. At 10 microM, MK-801 attenuated the development of long-term potentiation, but had no attenuating effect upon the previously-potentiated population spike. Similarly, 10 microM MK-801 attenuated the development of epileptiform activity in area CA3, but had little or no effect on the previously-established bursting in area CA3. These data support the suggestion that MK-801 exerts an antiepileptogenic, but not an anticonvulsant effect, at concentrations which also inhibit long-term potentiation.

N-methyl-D-aspartate receptor autoradiography in rat brain after angular bundle kindling

The specific binding of L-[3H]glutamate to N-methyl-D-aspartate (NMDA) receptors in brain regions of kindled rats was visualized autoradiographically and quantitated. When assayed 28 days after the last evoked seizure, NMDA receptor binding had declined by 7-11% in stratum radiatum of the dorsal hippocampal area CA1, in both deep and superficial layers of the motor cortex and in layers I-IV of the somatosensory cortex. No significant changes were detected in any other brain region nor in any region examined 1 day after the last evoked seizure. These findings suggest that the enhanced activation of NMDA receptors in kindled rats cannot be explained by an increased expression of these receptors. Rather, kindling leads to a regionally-selective down regulation of NMDA receptor binding.

Phencyclidine-like effect of cyclazocine on pentylentetrazol-induced seizures in laboratory animals

The present work deals with an EEG and behavioural study of the effect of cyclazocine against the convulsions due to pentylentetrazol (PTZ) in mice, rats and rabbits. In rats, cyclazocine, at the high doses (15-25 mg/kg) prevents the tonic motor convulsions and EEG epileptiform "grand mal" seizure induced by PTZ. In rabbits and mice, cyclazocine inhibits the tonic motor convulsions without modifying either the spike-frequency or the duration of the PTZ-induced EEG seizures. Naloxone, even at high doses, was not able to block the anticonvulsive effects of cyclazocine on PTZ-induced convulsions in the rat. The effects of cyclazocine were compared to those of phencyclidine. These results confirm the multiple behavioural effects of cyclazocine and support the idea that both cyclazocine and phencyclidine, may act on the PCP/sigma receptor identified in binding studies.