A unifying concept of seizure onset and termination

The effect of interventions based on the programs of The Institutes for the Achievement of Human Potential and Family Hope Center

OBJECTIVE

To compare the effect of the programs of IAHP and FHC with ordinary community-based programs.

METHOD

Two-year observational study of two groups of children aged 2-15 years who were following the IAHP and FHC programs (N = 18) or community-based programs (N = 17), with additional material from interviews with parents, and a retrospective study (N = 9) based on file records and parent interviews.

RESULTS

Changes in motor and cognitive function, language and behavior in the IAHP/FHC group well below the claims made by these programs, and few differences between this group and the comparison group. Intervention satisfaction lower prior to IAHP/FHC intervention than in the comparison group, and increased when moved to IAHP and FHC, independent of the children's progress.

CONCLUSION

The substantial claims of superiority compared to other interventions made by IAHP and FHC are not supported, but parents appear to be met in a positive manner in these programs.

Functional, metabolic, and synaptic changes after seizures as potential targets for antiepileptic therapy

Little is known about how the brain limits seizure duration and terminates seizures. Depending on severity and duration, a single seizure is followed by various functional, metabolic, and synaptic changes that may form targets for novel therapeutic strategies. It is long known that most seizures are followed by a period of postictal refractoriness during which the threshold for induction of additional seizures is increased. The endogenous anticonvulsant mechanisms involved in this phenomenon may be relevant for both spontaneous seizure arrest and increase of seizure threshold after seizure arrest. Postictal refractoriness has been extensively studied in various seizure and epilepsy models, including electrically and chemically induced seizures, kindling, and genetic animal models of epilepsy. During kindling development, two antagonistic processes occur simultaneously, one responsible for kindling-like events and the other for terminating ictus and postictal refractoriness. Frequently occurring seizures may lead to an accumulation of postictal refractoriness that may last weeks. The mechanisms involved in seizure termination and postictal refractoriness include changes in ionic microenvironment, in pH, and in various endogenous neuromodulators such as adenosine and neuropeptides. In animal models, the anticonvulsant efficacy of several antiepileptic drugs (AEDs) is increased during postictal refractoriness, which is a logical consequence of the interaction between endogenous anticonvulsant processes and the mechanism of AEDs. As discussed in this review, enhanced understanding of these endogenous processes may lead to novel targets for AED development.

Seizure clustering

Seizure clusters, also known as repetitive or serial seizures, occur commonly in epilepsy. Clustering implies that the occurrence of one seizure may influence the probability of a subsequent seizure; thus, the investigation of the clustering phenomenon yields insights into both specific mechanisms of seizure clustering and more general concepts of seizure occurrence. Seizure clustering has been defined clinically as a number of seizures per unit time and, statistically, as a deviation from a random distribution, or interseizure interval dependence. This review explores the pathophysiology, epidemiology, and clinical implications of clustering, as well as other periodic patterns of seizure occurrence. Risk factors for experiencing clusters and potential precipitants of clustering are also addressed.

Correlation between shaking behaviors and seizure severity in five animal models of convulsive seizures

Wet dog shakes (WDS) and head shakes (HS) are associated with experimentally induced convulsive seizures. We sought to determine whether these behaviors are correlated or not with major (status epilepticus (SE) or fully kindled animals) or minor (non-SE or partially kindled animals) seizure severity. WDS are directly correlated with SE induced by intracerebral star fruit extract (Averrhoa carambola) injection and with kindled animals in the amygdala fast kindling model. On the other hand, WDS are inversely correlated with SE induced by intracerebral bicuculline and pilocarpine injections. Systemic pilocarpine in animals pretreated with methyl-scopolamine barely induced WDS or HS. The role of shaking behaviors may vary from ictal to anticonvulsant depending on the experimental seizure model, circuitries involved, and stimulus intensity. The physical presence of acrylic helmets may per se inhibit the HS response. Also, methyl-scopolamine, a drug incapable of crossing the blood-brain barrier, can induce HS in animals without acrylic helmets.