1
|
Ferlini L, Maenhout C, Crippa IA, Quispe-Cornejo AA, Creteur J, Taccone FS, Gaspard N. The association between the presence and burden of periodic discharges and outcome in septic patients: an observational prospective study. Crit Care 2023; 27:179. [PMID: 37161485 PMCID: PMC10170680 DOI: 10.1186/s13054-023-04475-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Sepsis-associated encephalopathy (SAE) is frequent in septic patients. Electroencephalography (EEG) is very sensitive to detect early epileptic abnormalities, such as seizures and periodic discharges (PDs), and to quantify their duration (the so-called burden). However, the prevalence of these EEG abnormalities in septic patients, as well as their effect on morbidity and mortality, are still unclear. The aims of this study were to assess whether the presence of electrographic abnormalities (i.e. the absence of reactivity, the presence and burden of seizures and PDs) was associated with functional outcome and mortality in septic patients and whether these abnormalities were associated with sepsis-associated encephalopathy (SAE). METHODS We prospectively included septic patients, without known chronic or acute intracranial disease or pre-existing acute encephalopathy, requiring ICU admission in a tertiary academic centre. Continuous EEG monitoring was started within 72 h after inclusion and performed for up to 7 days. A comprehensive assessment of consciousness and delirium was performed twice daily by a trained neuropsychologist. Primary endpoints were unfavourable functional outcome (UO, defined as a Glasgow Outcome Scale-Extended-GOSE-score < 5), and mortality collected at hospital discharge and secondary endpoint was the association of PDs with SAE. Mann-Whitney, Fisher's exact and χ2 tests were used to assess differences in variables between groups, as appropriate. Multivariable logistic regression analysis with in-hospital mortality, functional outcome, SAE or PDs as the dependent variables were performed. RESULTS We included 92 patients. No seizures were identified. Nearly 25% of patients had PDs. The presence of PDs and PDs burden was associated with UO in univariate (n = 15 [41%], p = 0.005 and p = 0.008, respectively) and, for PDs presence, also in multivariate analysis after correcting for disease severity (OR 3.82, IC 95% [1.27-11.49], p = 0.02). The PDs burden negatively correlated with GOSE (Spearman's coefficient ρ = - 0.2, p = 0.047). The presence of PDs was also independently associated with SAE (OR 8.98 [1.11-72.8], p = 0.04). Reactivity was observed in the majority of patients and was associated with outcomes (p = 0.044 for both functional outcome and mortality). CONCLUSION Our findings suggest that PDs and PDs burden are associated with SAE and might affect outcome in septic patients.
Collapse
Affiliation(s)
- Lorenzo Ferlini
- Department of Neurology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
| | - Christelle Maenhout
- Department of Neurology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
| | - Ilaria Alice Crippa
- Department of Anesthesiology and Intensive Care, Policlinico San Marco, Gruppo San Donato, Zingonia, Italy
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Jacques Creteur
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Gaspard
- Department of Neurology, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
2
|
Hophing L, Kyriakopoulos P, Bui E. Sex and gender differences in epilepsy. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:235-276. [PMID: 36038205 DOI: 10.1016/bs.irn.2022.06.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sex and gender differences in epilepsy are important influencing factors in epilepsy care. In epilepsy, the hormonal differences between the sexes are important as they impact specific treatment considerations for patients at various life stages particularly during early adulthood with establishment of the menstrual cycle, pregnancy, perimenopause and menopause. Choice of antiseizure medication may have direct consequences on hormonal cycles, hormonal contraception, pregnancy and fetal risk of major congenital malformation. Conversely hormones whether intrinsic or extrinsically administered may have direct impact on antiseizure medications and seizure control. This chapter explores these important influences on the management of persons with epilepsy.
Collapse
Affiliation(s)
- Lauren Hophing
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada
| | | | - Esther Bui
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada.
| |
Collapse
|
3
|
Reddy DS. Brain structural and neuroendocrine basis of sex differences in epilepsy. HANDBOOK OF CLINICAL NEUROLOGY 2021; 175:223-233. [PMID: 33008527 DOI: 10.1016/b978-0-444-64123-6.00016-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This chapter reviews the current information about sex differences in epilepsy and potential mechanisms underlying sex differences in seizure susceptibility and epilepsy. The susceptibility to and occurrence of seizures are generally higher in men than women. There is gender-specific epilepsies such as catamenial epilepsy, a neuroendocrine condition in which seizures are most often clustered around the perimenstrual or periovulatory period in adult women. Structural differences in cerebral morphology, the structural and functional circuits may render men and women differentially vulnerable to seizure disorders and epileptogenic processes. Changes in seizure sensitivity are evident at puberty, pregnancy, and menopause, often attributed to circulating steroid hormones and neurosteroids as well as neuroplasticity in receptor systems. An improved understanding of the sexual dimorphism in neural circuits and the neuroendocrine basis of sex differences or resistance to protective drugs is essential to develop sex-specific therapies for seizure conditions.
Collapse
Affiliation(s)
- Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX, United States.
| |
Collapse
|
4
|
Wei B, Zhao X, Shi L, Xu L, Liu T, Zhang J. A deep learning framework with multi-perspective fusion for interictal epileptiform discharges detection in scalp electroencephalogram. J Neural Eng 2021; 18. [PMID: 34157696 DOI: 10.1088/1741-2552/ac0d60] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/22/2021] [Indexed: 11/11/2022]
Abstract
Objective.Interictal epileptiform discharges (IEDs) are an important and widely accepted biomarker used in the diagnosis of epilepsy based on scalp electroencephalography (EEG). Because the visual detection of IEDs has various limitations, including high time consumption and high subjectivity, a faster, more robust, and automated IED detector is strongly in demand.Approach.Based on deep learning, we proposed an end-to-end framework with multi-scale morphologic features in the time domain and correlation in sensor space to recognize IEDs from raw scalp EEG.Main Results.Based on a balanced dataset of 30 patients with epilepsy, the results of the five-fold (leave-6-patients-out) cross-validation shows that our model achieved state-of-the-art detection performance (accuracy: 0.951, precision: 0.973, sensitivity: 0.938, specificity: 0.968, F1 score: 0.954, AUC: 0.973). Furthermore, our model maintained excellent IED detection rates in an independent test on three datasets.Significance.The proposed model could be used to assist neurologists in clinical EEG interpretation of patients with epilepsy. Additionally, this approach combines multi-level output and correlation among EEG sensors and provides new ideas for epileptic biomarker detection in scalp EEG.
Collapse
Affiliation(s)
- Boxuan Wei
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, People's Republic of China.,Heifei Innovation Research Institute, Beihang University, Hefei 230012, People's Republic of China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing 100191, People's Republic of China.,Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, People's Republic of China
| | - Xiaohui Zhao
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, People's Republic of China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing 100191, People's Republic of China.,Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, People's Republic of China
| | - Lijuan Shi
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, People's Republic of China.,Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, People's Republic of China
| | - Lu Xu
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, People's Republic of China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing 100191, People's Republic of China
| | - Tao Liu
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, People's Republic of China
| | - Jicong Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing 100191, People's Republic of China.,Heifei Innovation Research Institute, Beihang University, Hefei 230012, People's Republic of China.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing 100191, People's Republic of China.,Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, Beihang University, Beijing 100191, People's Republic of China
| |
Collapse
|
5
|
Christian CA, Reddy DS, Maguire J, Forcelli PA. Sex Differences in the Epilepsies and Associated Comorbidities: Implications for Use and Development of Pharmacotherapies. Pharmacol Rev 2021; 72:767-800. [PMID: 32817274 DOI: 10.1124/pr.119.017392] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The epilepsies are common neurologic disorders characterized by spontaneous recurrent seizures. Boys, girls, men, and women of all ages are affected by epilepsy and, in many cases, by associated comorbidities as well. The primary courses of treatment are pharmacological, dietary, and/or surgical, depending on several factors, including the areas of the brain affected and the severity of the epilepsy. There is a growing appreciation that sex differences in underlying brain function and in the neurobiology of epilepsy are important factors that should be accounted for in the design and development of new therapies. In this review, we discuss the current knowledge on sex differences in epilepsy and associated comorbidities, with emphasis on those aspects most informative for the development of new pharmacotherapies. Particular focus is placed on sex differences in the prevalence and presentation of various focal and generalized epilepsies; psychiatric, cognitive, and physiologic comorbidities; catamenial epilepsy in women; sex differences in brain development; the neural actions of sex and stress hormones and their metabolites; and cellular mechanisms, including brain-derived neurotrophic factor signaling and neuronal-glial interactions. Further attention placed on potential sex differences in epilepsies, comorbidities, and drug effects will enhance therapeutic options and efficacy for all patients with epilepsy. SIGNIFICANCE STATEMENT: Epilepsy is a common neurological disorder that often presents together with various comorbidities. The features of epilepsy and seizure activity as well as comorbid afflictions can vary between men and women. In this review, we discuss sex differences in types of epilepsies, associated comorbidities, pathophysiological mechanisms, and antiepileptic drug efficacy in both clinical patient populations and preclinical animal models.
Collapse
Affiliation(s)
- Catherine A Christian
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Doodipala Samba Reddy
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Jamie Maguire
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| | - Patrick A Forcelli
- Department of Molecular and Integrative Physiology, Neuroscience Program, and Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, Illinois (C.A.C.); Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, Texas (D.S.R.); Neuroscience Department, Tufts University School of Medicine, Boston, Massachusetts (J.M.); and Departments of Pharmacology and Physiology and Neuroscience, Georgetown University, Washington, D.C. (P.A.F.)
| |
Collapse
|
6
|
O'Dwyer R. Epilepsy: Workup and Management in Adults. Semin Neurol 2020; 40:624-637. [PMID: 33176373 DOI: 10.1055/s-0040-1719069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
When managing epilepsy, there is a temptation to focus care with respect to the last and the next seizure. However, epilepsy is a multifaceted chronic condition and should be treated as such. Epilepsy comes with many physical risks, psychological effects, and socioeconomic ramifications, demanding a long-term commitment from the treating physician. Patients with epilepsy, compared to other chronically ill patient populations, have a worse quality of life, family function, and less social support. The majority of patients are well controlled on antiseizure drugs. However, approximately one-third will continue to have seizures despite optimized medical management. The primary aim of this article is to explore the long-term management of chronic epilepsy, and to address some of the particular needs of patients with chronic epilepsy.
Collapse
Affiliation(s)
- Rebecca O'Dwyer
- Department of Neurological Science, Rush University Medical Center, Chicago, Illinois
| |
Collapse
|
7
|
Bernard C. Circadian/multidien Molecular Oscillations and Rhythmicity of Epilepsy (MORE). Epilepsia 2020; 62 Suppl 1:S49-S68. [PMID: 33063860 DOI: 10.1111/epi.16716] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 12/26/2022]
Abstract
The occurrence of seizures at specific times of the day has been consistently observed for centuries in individuals with epilepsy. Electrophysiological recordings provide evidence that seizures have a higher probability of occurring at a given time during the night and day cycle in individuals with epilepsy here referred to as the seizure rush hour. Which mechanisms underlie such circadian rhythmicity of seizures? Why don't they occur every day at the same time? Which mechanisms may underlie their occurrence outside the rush hour? In this commentary, I present a hypothesis: MORE - Molecular Oscillations and Rhythmicity of Epilepsy, a conceptual framework to study and understand the mechanisms underlying the circadian rhythmicity of seizures and their probabilistic nature. The core of the hypothesis is the existence of ~24-hour oscillations of gene and protein expression throughout the body in different cells and organs. The orchestrated molecular oscillations control the rhythmicity of numerous body events, such as feeding and sleep. The concept developed here is that molecular oscillations may favor seizure genesis at preferred times, generating the condition for a seizure rush hour. However, the condition is not sufficient, as other factors are necessary for a seizure to occur. Studying these molecular oscillations may help us understand seizure genesis mechanisms and find new therapeutic targets and predictive biomarkers. The MORE hypothesis can be generalized to comorbidities and the slower multidien (week/month period) rhythmicity of seizures, a phenomenon addressed in another article in this issue of Epilepsia.
Collapse
Affiliation(s)
- Christophe Bernard
- Inserm, INS, Institut de Neurosciences des Systèmes, Aix Marseille Univ, Marseille, France
| |
Collapse
|
8
|
Markoula S, Siarava E, Kostoulas C, Zikopoulos A, Georgiou I. An open study of valproate in subfertile men with epilepsy. Acta Neurol Scand 2020; 142:317-322. [PMID: 33378111 DOI: 10.1111/ane.13311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/17/2020] [Accepted: 06/28/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES The aim of the study was to assess whether, male patients with epilepsy, switching from valproic acid (VPA) to levetiracetam (LEV) or lamotrigine (LMG) critically improves sperm counts and parameters, increasing chance of patients' female partners to spontaneously conceive. MATERIALS AND METHODS This is an observational prospective study recruiting all consecutive infertile male patients with epilepsy followed up at the outpatient Epilepsy Clinic of University Hospital of Ioannina, Northwest Greece. Infertile couples were referred to the Laboratory of Assisted Reproduction and Treatment of the University Hospital of Ioannina to conduct semen analysis. The first sample was collected while the patients were receiving VPA, and the second semen sample was collected after the patients were switched to LEV or LMG. RESULTS Seventeen infertile male patients were recruited in the study. Nine patients were switched to LEV, and eight patients were switched to LMG. The mean sperm count increased after VPA withdraw P = .06. Motility was improved with an increase of total motility and non-progressive motility (P = .02 and P = .03, accordingly), whether sperm defects were decreased, mainly head defects (P = .03). Differences between patients switched to LEV or LMG were minimal and showed no significant findings. Spontaneous pregnancies were reported in three of the patients' partners, without any other clinical intervention offered to the couple. CONCLUSION Switching from valproic acid to levetiracetam or lamotrigine improved sperm counts and other sperm parameters in subfertile male patients and increased the chance of spontaneously conceiving in subfertile couples.
Collapse
Affiliation(s)
- Sofia Markoula
- Department of Neurology University of Ioannina Ioannina Greece
- University Hospital of Ioannina Ioannina Greece
| | - Eleftheria Siarava
- Department of Neurology University of Ioannina Ioannina Greece
- University Hospital of Ioannina Ioannina Greece
| | | | | | - Ioannis Georgiou
- Laboratory of Assisted Reproduction University of Ioannina Ioannina Greece
| |
Collapse
|
9
|
Huerta-Franco MR, Ulloa-Aguirre A, Gerónimo AL, Capaccione K, Marquez-Romero JM. Mood variations and personality traits in patients with epilepsy over the course of their menstrual cycle. Epilepsy Behav 2020; 105:106990. [PMID: 32160588 DOI: 10.1016/j.yebeh.2020.106990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The incidence of mood disorders and psychopathology is more frequent in patients with epilepsy (PWE) than in the general population. Also, it has been reported that PWE suffer more seizures during certain phases of their menstrual cycle (MC). Still, limited information exists regarding the relationship between the physical and emotional changes during the MC in PWE. Therefore, in this study, we aimed to evaluate the mood and personality traits of PWE during their MC and to compare them with controls. METHODS A cohort of 22 PWE and nine controls was gathered. All the participants underwent psychiatric, electroencephalographic, and gynecological evaluations. RESULTS Overall, PWE scored higher in depression compared with controls (p < 0.05), PWE also obtained higher scores for the personality traits of neuroticism and self-isolation (p < 0.05). During the evaluation of the symptoms of premenstrual syndrome (PMS), PWE were more symptomatic during the early follicular (EF) phase in comparison with the rest of the phases of their MC, whereas the control group showed the known premenstrual pattern of symptoms during the late luteal (LL) phase. The frequency of seizures (40.6%) and electroencephalographic abnormalities (34.8%) was also higher during the EF phase of the MC when compared with the other phases of the MC (p < 0.05). CONCLUSIONS The results of this study suggest that unlike the PMS present in women without epilepsy, PWE appear to show a "menstrual syndrome" that consists of similar mood changes and physical symptoms. This arrangement of symptoms seems to have an impact on the increase in seizure activity.
Collapse
Affiliation(s)
- María Raquel Huerta-Franco
- Departamento de Ciencias Aplicadas al Trabajo, Universidad de Guanajuato, Av. Eugenio Garza Sada 572, Lomas del Campestre Sección 2, León, Guanajuato 37150, Mexico
| | - Alicia Ulloa-Aguirre
- Departamento de Biología de la Reproducción, Hospital Luis Castelazo Ayala, Instituto Mexicano del Seguro Social (IMSS), Avenida Eje 10 Sur 289, Tizxapan San Ángel, Álvaro Obregón, CDMX 1090, Mexico
| | - Aguayo-Leytte Gerónimo
- Departamento de Neurología, Hospital Miguel Hidalgo, Av. Ferrocarril S/N, Alameda, Aguascalientes 20259, Mexico
| | - Kathleen Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York 10032, United States
| | - Juan Manuel Marquez-Romero
- Instituto Mexicano del Seguro Social (IMSS) HGZ 2, Av. de, Los Conos 102, Ojocaliente, Aguascalientes 20190, Mexico.
| |
Collapse
|
10
|
Management of epilepsy in women. Lancet Neurol 2019; 18:481-491. [DOI: 10.1016/s1474-4422(18)30495-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/19/2018] [Accepted: 12/10/2018] [Indexed: 01/01/2023]
|
11
|
Lalitha S, Minz RW, Medhi B. Understanding the controversial drug targets in epilepsy and pharmacoresistant epilepsy. Rev Neurosci 2018; 29:333-345. [PMID: 29211683 DOI: 10.1515/revneuro-2017-0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/11/2017] [Indexed: 12/18/2022]
Abstract
Accumulating experimental data suggests a number of successful drug targets against epilepsy which eventually failed in the clinical setup. Mammalian target of rapamycin inhibitors, multi-drug resistance transporter inhibitors, cyclo-oxygenase-2 inhibitors, statins, etc. are the most promising and well studied among them. Drugs aiming at these targets produced beneficial response in most of the in vitro and in vivo seizure models. However, in certain situations, they have produced differential rather controversial results. Their effects varied with the seizure model, species, time and route of administration, different drugs from the same class, etc. This review emphasises on such drugs which presented with variability in their beneficial effects against seizures and epilepsy. This review critically summarises the preclinical evidence of these targets in the context of seizures and the probable reasons for their variability and clinical failures.
Collapse
Affiliation(s)
- Sree Lalitha
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ranjana W Minz
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Bikash Medhi
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| |
Collapse
|
12
|
Abstract
This article highlights the emerging therapeutic potential of specific epigenetic modulators as promising antiepileptogenic or disease-modifying agents for curing epilepsy. Currently, there is an unmet need for antiepileptogenic agents that truly prevent the development of epilepsy in people at risk. There is strong evidence that epigenetic signaling, which exerts high fidelity regulation of gene expression, plays a crucial role in the pathophysiology of epileptogenesis and chronic epilepsy. These modifications are not hard-wired into the genome and are constantly reprogrammed by environmental influences. The potential epigenetic mechanisms, including histone modifications, DNA methylation, microRNA-based transcriptional control, and bromodomain reading activity, can drastically alter the neuronal gene expression profile by exerting their summative effects in a coordinated fashion. Such an epigenetic intervention appears more rational strategy for preventing epilepsy because it targets the primary pathway that initially triggers the numerous downstream cellular and molecular events mediating epileptogenesis. Among currently approved epigenetic drugs, the majority are anticancer drugs with well-established profiles in clinical trials and practice. Evidence from preclinical studies supports the premise that these drugs may be applied to a wide range of brain disorders. Targeting histone deacetylation by inhibiting histone deacetylase enzymes appears to be one promising epigenetic therapy since certain inhibitors have been shown to prevent epileptogenesis in animal models. However, developing neuronal specific epigenetic modulators requires rational, pathophysiology-based optimization to efficiently intercept the upstream pathways in epileptogenesis. Overall, epigenetic agents have been well positioned as new frontier tools towards the national goal of curing epilepsy.
Collapse
Affiliation(s)
- Iyan Younus
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA
| | - Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA.
| |
Collapse
|
13
|
Reddy DS, Bhimani A, Kuruba R, Park MJ, Sohrabji F. Prospects of modeling poststroke epileptogenesis. J Neurosci Res 2017; 95:1000-1016. [PMID: 27452210 PMCID: PMC5266751 DOI: 10.1002/jnr.23836] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 12/20/2022]
Abstract
This Review describes the current status of poststroke epilepsy (PSE) with an emphasis on poststroke epileptogenesis modeling for testing new therapeutic agents. Stroke is a leading cause of epilepsy in an aging population. Late-onset "epileptic" seizures have been reported in up to 30% cases after stroke. Nevertheless, the overall prevalence of PSE is 2-4%. Rodent models of stroke have contributed to our understanding of the relationship between seizures and the underlying ischemic damage to neurons. To understand whether acutely generated stroke events lead to a chronic phenotype more closely resembling PSE with recurrent seizures, a limited variety of approaches emerged in early 2000s. These limited methods of causing an occlusion in mice and rats show different infarct size and neurological deficits. The most often employed procedure for inducing focal ischemia is the middle cerebral artery occlusion. This mimics the pathophysiology seen in humans in terms of extent of damage to cortex and striatum. Photothrombosis and endothelin-1 models can similarly evoke episodes of ischemic stroke. These models are well suited to studying mechanisms and biomarkers of epileptogenesis or optimizing novel drug discoveries. However, modeling of PSE is tedious, is highly variable, and lacks validity; therefore, it is not widely implemented in epilepsy research. Moreover, the relevance of ischemic models to specific forms of human stroke remains unclear. Stroke modeling in young male rodents lacks clinical relevance to elderly populations and especially to women, likely as a result of sex differences. Nevertheless, because of the neuronal damage and epileptogenic insult that these models trigger, they are helpful tools in studying acquired epilepsy and prophylactic drug therapy. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Aamir Bhimani
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Ramkumar Kuruba
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Min Jung Park
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| | - Farida Sohrabji
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA
| |
Collapse
|
14
|
Auerbach DS, McNitt S, Gross RA, Zareba W, Dirksen RT, Moss AJ. Genetic biomarkers for the risk of seizures in long QT syndrome. Neurology 2016; 87:1660-1668. [PMID: 27466471 DOI: 10.1212/wnl.0000000000003056] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/26/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The coprevalence, severity, and biomarkers for seizures and arrhythmias in long QT syndrome (LQTS) remain incompletely understood. METHODS Using the Rochester-based LQTS Registry, this study included large cohorts of LQTS1-3 participants (LQTS+, n = 965) and those without a LQTS mutation (LQTS-, n = 936). RESULTS Compared to LQTS- participants, there was a higher prevalence of LQTS1, LQTS2, and LQTS+ participants classified as having seizures (p < 0.001, i.e., history of seizures/epilepsy or antiseizure medication). LQTS+ participants with longer corrected QT interval (QTc) durations were more likely to have seizures. LQTS2 mutations in the KCNH2 pore domain were positive predictors for both arrhythmias and seizures. In contrast, mutations in the cyclic nucleotide binding domain (cNBD) of KCNH2 conferred a negative risk of seizures, but not arrhythmias. LQTS2, KCNH2-pore, KCNH2-cNBD, QTc duration, and sex were independent predictors of seizures. LQTS+ participants with seizures had significantly longer QTc durations, and a history of seizures was the strongest independent predictor of arrhythmias (hazard ratio 4.09, 95% confidence interval 2.63-6.36, p < 0.001). CONCLUSIONS This study highlights potential biomarkers for neurocardiac electrical abnormalities in LQTS.
Collapse
Affiliation(s)
- David S Auerbach
- From the Department of Medicine, Aab Cardiovascular Research Institute (D.S.A.), Department of Medicine, Heart Research Follow-up Program (S.M., W.Z., A.J.M.), and Departments of Neurology (R.A.G.) and Pharmacology & Physiology (R.A.G., R.T.D.), University of Rochester School of Medicine and Dentistry, Rochester, NY.
| | - Scott McNitt
- From the Department of Medicine, Aab Cardiovascular Research Institute (D.S.A.), Department of Medicine, Heart Research Follow-up Program (S.M., W.Z., A.J.M.), and Departments of Neurology (R.A.G.) and Pharmacology & Physiology (R.A.G., R.T.D.), University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Robert A Gross
- From the Department of Medicine, Aab Cardiovascular Research Institute (D.S.A.), Department of Medicine, Heart Research Follow-up Program (S.M., W.Z., A.J.M.), and Departments of Neurology (R.A.G.) and Pharmacology & Physiology (R.A.G., R.T.D.), University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Wojciech Zareba
- From the Department of Medicine, Aab Cardiovascular Research Institute (D.S.A.), Department of Medicine, Heart Research Follow-up Program (S.M., W.Z., A.J.M.), and Departments of Neurology (R.A.G.) and Pharmacology & Physiology (R.A.G., R.T.D.), University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Robert T Dirksen
- From the Department of Medicine, Aab Cardiovascular Research Institute (D.S.A.), Department of Medicine, Heart Research Follow-up Program (S.M., W.Z., A.J.M.), and Departments of Neurology (R.A.G.) and Pharmacology & Physiology (R.A.G., R.T.D.), University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Arthur J Moss
- From the Department of Medicine, Aab Cardiovascular Research Institute (D.S.A.), Department of Medicine, Heart Research Follow-up Program (S.M., W.Z., A.J.M.), and Departments of Neurology (R.A.G.) and Pharmacology & Physiology (R.A.G., R.T.D.), University of Rochester School of Medicine and Dentistry, Rochester, NY
| |
Collapse
|
15
|
Reddy DS. The neuroendocrine basis of sex differences in epilepsy. Pharmacol Biochem Behav 2016; 152:97-104. [PMID: 27424276 DOI: 10.1016/j.pbb.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 06/25/2016] [Accepted: 07/12/2016] [Indexed: 01/22/2023]
Abstract
Epilepsy affects people of all ages and both genders. Sex differences are well known in epilepsy. Seizure susceptibility and the incidence of epilepsy are generally higher in men than women. In addition, there are gender-specific epilepsies such as catamenial epilepsy, a neuroendocrine condition in which seizures are most often clustered around the perimenstrual or periovulatory period in adult women with epilepsy. Changes in seizure sensitivity are also evident at puberty, pregnancy, and menopause. Sex differences in seizure susceptibility and resistance to antiseizure drugs can be studied in experimental models. An improved understanding of the neuroendocrine basis of sex differences or resistance to protective drugs is essential to develop targeted therapies for sex-specific seizure conditions. This article provides a brief overview of the current status of sex differences in seizure susceptibility and the potential mechanisms underlying the gender differences in seizure sensitivity.
Collapse
Affiliation(s)
- Doodipala Samba Reddy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M University Health Science Center, Bryan, TX 77807, USA.
| |
Collapse
|
16
|
Goldman AM, LaFrance WC, Benke T, Asato M, Drane D, Pack A, Syed T, Doss R, Lhatoo S, Fureman B, Dingledine R. 2014 Epilepsy Benchmarks Area IV: Limit or Prevent Adverse Consequence of Seizures and Their Treatment Across The Lifespan. Epilepsy Curr 2016; 16:198-205. [PMID: 27330453 PMCID: PMC4913859 DOI: 10.5698/1535-7511-16.3.198] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Alica M. Goldman
- Associate Professor, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB222, Houston, TX, USA
| | - W. Curt LaFrance
- Associate Professor, Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Providence RI 02903-4923 USA
| | - Tim Benke
- Associate Professor, Departments of Pediatrics, Neurology, Pharmacology and Otolaryngology, University of Colorado School of Medicine, Aurora, CO
| | - Miya Asato
- Associate Professor, Pediatrics and Psychiatry, Divisionof Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Dan Drane
- Assistant Professor, Departments of Neurology and Pediatrics, Emory University School of Medicine and Department of Neurology, University of Washington School of Medicine
| | - Alison Pack
- Associate Professor of Neurology, Department of Neurology, Columbia University Medical Center, New York, NY
| | - Tanvir Syed
- Assistant Professor of Neurology, University Hospitals Case Medical Center, Cleveland, OH
| | - Robert Doss
- Clinical Neuropsychologist, Minnesota Epilepsy Group, P.A., St. Paul, MN and Department of Neurology, University of Minnesota-Twin Cities, MN
| | - Samden Lhatoo
- Professor and Chair, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Brandy Fureman
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Ray Dingledine
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta GA
| | - for the American Epilepsy Society (AES)/National Institute of Neurological Disorders and Stroke (NINDS) Epilepsy Benchmark Stewards.
- Associate Professor, Department of Neurology, Baylor College of Medicine, One Baylor Plaza, NB222, Houston, TX, USA
- Associate Professor, Departments of Neurology and Psychiatry, Alpert Medical School, Brown University, Providence RI 02903-4923 USA
- Associate Professor, Departments of Pediatrics, Neurology, Pharmacology and Otolaryngology, University of Colorado School of Medicine, Aurora, CO
- Associate Professor, Pediatrics and Psychiatry, Divisionof Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA
- Assistant Professor, Departments of Neurology and Pediatrics, Emory University School of Medicine and Department of Neurology, University of Washington School of Medicine
- Associate Professor of Neurology, Department of Neurology, Columbia University Medical Center, New York, NY
- Assistant Professor of Neurology, University Hospitals Case Medical Center, Cleveland, OH
- Clinical Neuropsychologist, Minnesota Epilepsy Group, P.A., St. Paul, MN and Department of Neurology, University of Minnesota-Twin Cities, MN
- Professor and Chair, Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH
- Program Director, Channels Synapses and Circuits Cluster, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
- Professor and Chair, Department of Pharmacology, Emory University, Atlanta GA
| |
Collapse
|
17
|
Opportunities for improving animal welfare in rodent models of epilepsy and seizures. J Neurosci Methods 2015; 260:2-25. [PMID: 26376175 DOI: 10.1016/j.jneumeth.2015.09.007] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/01/2015] [Accepted: 09/08/2015] [Indexed: 01/31/2023]
Abstract
Animal models of epilepsy and seizures, mostly involving mice and rats, are used to understand the pathophysiology of the different forms of epilepsy and their comorbidities, to identify biomarkers, and to discover new antiepileptic drugs and treatments for comorbidities. Such models represent an important area for application of the 3Rs (replacement, reduction and refinement of animal use). This report provides background information and recommendations aimed at minimising pain, suffering and distress in rodent models of epilepsy and seizures in order to improve animal welfare and optimise the quality of studies in this area. The report includes practical guidance on principles of choosing a model, induction procedures, in vivo recordings, perioperative care, welfare assessment, humane endpoints, social housing, environmental enrichment, reporting of studies and data sharing. In addition, some model-specific welfare considerations are discussed, and data gaps and areas for further research are identified. The guidance is based upon a systematic review of the scientific literature, survey of the international epilepsy research community, consultation with veterinarians and animal care and welfare officers, and the expert opinion and practical experience of the members of a Working Group convened by the United Kingdom's National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs).
Collapse
|
18
|
|
19
|
Affiliation(s)
- Aristea S Galanopoulou
- Saul R. Korey Department of Neurology, Dominick P. Purpura Department of Neuroscience, Laboratory of Developmental Epilepsy, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
| |
Collapse
|
20
|
Sex, epilepsy, and epigenetics. Neurobiol Dis 2014; 72 Pt B:210-6. [PMID: 24998474 DOI: 10.1016/j.nbd.2014.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/19/2014] [Accepted: 06/24/2014] [Indexed: 02/05/2023] Open
Abstract
Epilepsy refers to a heterogeneous group of disorders that are associated with a wide range of pathogenic mechanisms, seizure manifestations, comorbidity profiles, and therapeutic responses. These characteristics are all influenced quite significantly by sex. As with other conditions exhibiting such patterns, sex differences in epilepsy are thought to arise-at the most fundamental level-from the "organizational" and "activational" effects of sex hormones as well as from the direct actions of the sex chromosomes. However, our understanding of the specific molecular, cellular, and network level processes responsible for mediating sex differences in epilepsy remains limited. Because increasing evidence suggests that epigenetic mechanisms are involved both in epilepsy and in brain sexual dimorphism, we make the case here that analyzing epigenetic regulation will provide novel insights into the basis for sex differences in epilepsy.
Collapse
|