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

Anti-NMDAR encephalitis in Southeast Asia - A single-centre, longitudinal study

AIMS

To describe the clinical features and outcomes of anti-NMDA receptor encephalitis (ANMDARE) in Southeast Asian (SEA) patients.

METHOD

SEA patients diagnosed and treated for ANMDARE at Singapore General Hospital between January 2010 and June 2020 were included in this observational study, in which their clinical features and outcomes were retrospectively analysed.

RESULTS

We studied 20 patients: 11 Chinese, 3 Tagalogs, 2 Malays, 2 Indians, 1 Eurasian and 1 Javanese. Their median age was 28 years. 15 were females, amongst whom teratomas were demonstrated in 13 (12 ovarian, 1 mediastinal). Delirium and seizures were the two commonest events leading to their presentation at our facility. 1 male had biliary neuroendocrine tumour. Comparison between genders revealed a strong male predilection for early seizures and insomnia; females were four times likelier than males to develop movement disorders or have underlying neoplasms. Patients with dysautonomia required longer ICU stay beyond 14 days, but their outcomes at 1 year did not differ. When reviewed at 1 year, none had clinical relapses, and outcomes were favourable (mRS 0-2) in nearly two-thirds.

CONCLUSIONS

SEA patients with ANMDARE frequently present with delirium and seizures. Underlying neoplasms are very common in females. Differences in clinical characteristics may exist between the two genders. Recognition of these can facilitate diagnosis, and permit earlier initiation of appropriate treatment strategies, and thus improve outcomes of SEA patients.

Testosterone ameliorated the behavioural deficits of gonadectomised rats and counteracted free radicals in a dosage-dependent manner

Testosterone deficiency may induce behavioural changes in individuals. Oxidative stress resulting from a redox imbalance may be implicated in the initiation and progression of neurobehavioural disorders. However, whether exogenous testosterone intervention in male gonadectomised (GDX) rats ameliorates oxidative stress and plays a neuroprotective role remains unknown. Therefore, we examined this hypothesis by performing sham or gonadectomy surgeries on Sprague-Dawley rats with or without supplementation with different doses of testosterone propionate (TP). Open field and Morris water maze tests were performed, the serum and brain testosterone levels, and oxidative stress markers were analysed. GDX and lower TP doses (0.5mg/kg) induced reduced exploratory and motor behaviours, but impaired spatial learning and memory compared to Sham rats. Administration of physiological TP levels (0.75-1.25mg/kg) to the GDX rats restored the behaviour observed in the intact rats. However, higher TP doses (1.5-3.0mg/kg) induced increased exploratory and motor behaviours but impaired spatial learning and memory. These behavioural impairments were accompanied by a marked decrease in levels of antioxidant enzymes (superoxide dismutase and catalase) and an increase in lipid peroxidation levels in the substantia nigra and hippocampus. These findings indicate that TP administration can alter behavioural performance and induce memory and learning impairment, which may result from changes in redox homeostasis in male GDX animals.

Seizures in dogs under primary veterinary care in the United Kingdom: Etiology, diagnostic testing, and clinical management

Background

Although seizures are common in dogs, limited published information is available on the classifications of seizures, diagnostic approaches, or clinical management of seizure‐affected patients in the veterinary primary care setting.

Objectives

Explore seizure etiology, diagnostic testing, and clinical management of seizure‐affected dogs in the primary care veterinary setting.

Animals

A total of 455 553 dogs in VetCompass.

Methods

Cross‐sectional analysis by cohort clinical data.

Results

From 2834 incident seizure cases, we identified 579 (20.5%) dogs with epilepsy based on the International Veterinary Epilepsy Task Force (IVETF) classification system, including 484 (17.1%) with idiopathic epilepsy, 95 (3.4%) with structural epilepsy, and 179 dogs (6.3%) with reactive seizures. In their clinical first opinion records, 245 (8.6%) cases were recorded with epilepsy. Overall, 1415 (49.9%) cases received diagnostic evaluation equivalent to or higher than IVETF Tier 1 diagnostic testing.

Being <12 years of age and being insured were risk factors for receiving IVETF Tier 1 or higher diagnostic evaluation among seizure cases. Anti‐seizure drug (ASD) treatment was not prescribed for 1960/2834 (69.2%) dogs in association with the incident seizure event. Of the remainder, 719 (25.3%) dogs received 1 ASD, whereas 155 (5.5%) an ASD combination.

Conclusion and clinical importance

The differences between seizure classifications in the clinical records and those retrospectively assigned by the researchers support the need for clearer diagnostic guidelines in clinical practice. Insured dogs and dogs <12 years of age were more likely to receive advanced diagnostic evaluation, suggesting that financial and perceived prognostic factors influence case management.

Current Progress on Assessing the Prognosis for Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common antineuronal antibody encephalitis in autoimmune encephalitis found at present. It has complex clinical manifestations such as psychiatric and behavioral abnormalities, seizures, movement disorders, consciousness, and autonomic dysfunction. The relationship between those manifestations and prognosis is unclear. Electroencephalography (EEG) is gradually becoming useful in the evaluation of the prognosis of anti-NMDAR encephalitis patients, while imaging and antibody testing have a limited prognostic value. Starting the patients on adequate treatments (such as immunotherapy) in a timely fashion has a positive impact on their prognosis. Nevertheless, research on the prognosis of anti-NMDAR encephalitis remains scarce. Here, we review the current advances of prognosis-related research from the clinical manifestations of the disease and auxiliary examinations such as EEG, magnetic resonance imaging (MRI), 18F fluorodeoxyglucose positron emission tomography (FDG-PET), and antibody measurement. In addition, we also discuss the impact of different treatment options on prognosis. In-depth research on the prognosis of patients with anti-NMDAR encephalitis will contribute to a better understanding of this disease, leading to better treatments options and, ultimately, a better prognosis.

Seizure Characteristics, Outcome, and Risk of Epilepsy in Pediatric Anti-N-Methyl-d-Aspartate Receptor Encephalitis

BACKGROUND

We identified seizure characteristics, long-term outcome, and predictors of persistent seizures in children with anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis.

METHOD

Data were analyzed from patients with anti-NMDAR encephalitis who presented with seizures at our center between August 2012 and June 2018.

RESULTS

Sixty-two of 86 patients with anti-NMDAR encephalitis experienced seizures. Seizures occurred within two weeks of disease onset in 58 of 62 (93.6%) patients; 36 of 62 (58.1%) had seizures as the initial symptom. Males were more likely to exhibit seizures as the initial symptom (P = 0.039). More than a quarter of patients (17 of 62, 27.4%) manifested two or more seizure types. Focal seizures were the most common (46 of 62, 74.2%). Status epilepticus occurred in 27 of 62 (43.5%) patients, and nonconvulsive status epilepticus, in two of 62 (3.2%) patients. No patient developed refractory status epilepticus. No systemic tumors were found. Electroencephalographic abnormalities included background slowing (77.4%), absence of a posterior dominant rhythm (62.9%), interictal epileptic discharges (50.0%), and extreme delta brush (6.5%). In the acute phase, 45 patients (45 of 62, 72.6%) received antiepileptic drugs. Persistent seizures occurred in only five of 62 (8%) patients. On univariate analysis, status epilepticus and combination antiepileptic drug treatment were associated with persistent seizures, but neither independently predicted persistent seizures.

CONCLUSIONS

Multiple seizure types may develop at any stage of anti-N-methyl-d-aspartate receptor encephalitis. Refractory status epilepticus, systemic tumors, and extreme delta brush in electroencephalography are rare in pediatric patients. Anti-NMDAR encephalitis-associated seizures appear to have good prognosis, without the need for long-term antiepileptic drug treatment.

Neurosteroids and neuropathic pain management: Basic evidence and therapeutic perspectives

Complex mechanisms involved in neuropathic pain that represents a major health concern make its management complicated. Because neurosteroids are bioactive steroids endogenously synthesized in the nervous system, including in pain pathways, they appear relevant to develop effective treatments against neuropathic pain. Neurosteroids act in paracrine or autocrine manner through genomic mechanisms and/or via membrane receptors of neurotransmitters that pivotally modulate pain sensation. Basic studies which uncovered a direct link between neuropathic pain symptoms and endogenous neurosteroid production/regulation, paved the way for the investigations of neurosteroid therapeutic potential against pathological pain. Concordantly, antinociceptive properties of synthetic neurosteroids were evidenced in humans and animals. Neurosteroids promote peripheral analgesia mediated by T-type calcium and gamma-aminobutyric acid type A channels, counteract chemotherapy-induced neuropathic pain and ameliorate neuropathic symptoms of injured spinal cord animals by stimulating anti-inflammatory, remyelinating and neuroprotective processes. Together, these data open interesting perspectives for neurosteroid-based strategies to manage/alleviate efficiently neuropathic pain.

Seizure-precipitating factors in dogs with idiopathic epilepsy

Background

Stress, sleep deprivation, and infectious diseases are important seizure‐precipitating factors in human epilepsy patients. However, these factors have not been thoroughly studied in epileptic dogs.

Objective

Seizure‐precipitating factors are common in dogs with idiopathic epilepsy and the occurrence of these factors associate with the dogs' signalment, personality, and epilepsy‐related factors.

Animals

Fifty dogs with diagnosed idiopathic epilepsy from the hospital populations of University Veterinary Teaching Hospital of University of Helsinki and Referral Animal Hospital Aisti.

Methods

In a retrospective cross‐sectional observational study, owners were interviewed about their dogs' possible seizure‐precipitating factors according to a predefined questionnaire. The dogs were identified and selected by searching the medical records of the participating animal hospitals.

Results

The prevalence of seizure‐precipitating factors in the study population was 74% (37/50). The most frequently reported factors included stress‐related situations, sleep deprivation, weather, and hormonal factors. In dogs with focal onset seizures, the number of precipitating factors was 1.9 (95% CI 1.1‐3.4) times higher compared to dogs with generalized seizures.

Conclusions and Clinical Importance

Seizure‐precipitating factors are common in dogs with idiopathic epilepsy, and the nature of these factors is consistent with those of human patients. Aside from antiepileptic medication, acknowledging and avoiding seizure‐precipitating factors could help veterinarians achieve better treatment outcomes.

Initial clinical presentation of young children with N-methyl-d-aspartate receptor encephalitis

Autoimmune encephalitis with anti-N-methyl-d-aspartate receptor autoantibodies (NMDA-R-Abs) is a recently described disease affecting adult and pediatric patients. Symptoms of the disease are now perfectly described in the adult population but the clinical presentation is less known in young children. The aim of the present study was to describe the clinical presentation and the specificities of symptoms presented by young children with NMDA-R-Abs encephalitis to improve diagnosis of this disease, and to compare these to a series of previously published female adult patients. Fifty cases of children younger than twelve years of age diagnosed with NMDA-R-Abs encephalitis between January 1, 2007 and December 31, 2016 (27 females and 23 males) were retrospectively studied. The first neurological symptoms observed in young children with NMDA-R-Abs encephalitis were characterized by seizure (72%), especially focal seizure (42%), within a median of 15 days before other encephalitis symptoms; other patients mostly had behavioral disorders (26%). The seizures were frequently difficult to diagnose because of the transient unilateral dystonic or tonic posturing presentation or sudden unilateral pain in the absence of clonic movements. A post-ictal motor deficit was also frequently observed. This clinical presentation is different from that observed in adult females with NMDA-R-Abs encephalitis who initially present mainly psychiatric disorders (67%) or cognitive impairment (19%), and less frequently seizures (14%). The diagnosis of NMDA-R-Abs encephalitis should be systematically considered in young children of both sexes who present neurological symptoms suggesting recent seizures (focal or generalized) without obvious other etiology.

Human dehydrogenase/reductase (SDR family) member 11 is a novel type of 17β-hydroxysteroid dehydrogenase

We report characterization of a member of the short-chain dehydrogenase/reductase superfamily encoded in a human gene, DHRS11. The recombinant protein (DHRS11) efficiently catalyzed the conversion of the 17-keto group of estrone, 4- and 5-androstenes and 5α-androstanes into their 17β-hydroxyl metabolites with NADPH as a coenzyme. In contrast, it exhibited reductive 3β-hydroxysteroid dehydrogenase activity toward 5β-androstanes, 5β-pregnanes, 4-pregnenes and bile acids. Additionally, DHRS11 reduced α-dicarbonyls (such as diacetyl and methylglyoxal) and alicyclic ketones (such as 1-indanone and loxoprofen). The enzyme activity was inhibited in a mixed-type manner by flavonoids, and competitively by carbenoxolone, glycyrrhetinic acid, zearalenone, curcumin and flufenamic acid. The expression of DHRS11 mRNA was observed widely in human tissues, most abundantly in testis, small intestine, colon, kidney and cancer cell lines. Thus, DHRS11 represents a novel type of 17β-hydroxysteroid dehydrogenase with unique catalytic properties and tissue distribution.

Anti-NMDA receptor encephalitis: clinical characteristics, predictors of outcome and the knowledge gap in southwest China

BACKGROUND AND PURPOSE

The aim was to analyse the clinical profiles and outcomes of patients with anti- N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis in China.

METHODS

A retrospective study of anti-NMDAR encephalitis in China was performed between June 2011 and June 2014. The clinical characteristics and predictors of poor outcome were determined.

RESULTS

A total of 51 patients with a definitive diagnosis of anti-NMDAR encephalitis were included in this study. Four of them were surgically confirmed to have a neoplasm. Thirty-two patients, amongst whom 24 were female, presented with psychiatric disorder as the initial symptom, whereas 14 patients, of whom nine were male, presented with seizure as the initial symptom (P = 0.011). Twenty-nine patients (56.86%) were initially misdiagnosed with psychosis, viral encephalitis or other diseases, and 58.8% of the patients experienced at least one type of complication. It typically took 3 weeks before these patients were admitted to our hospital and another 2 weeks before the correct diagnosis was made. Forty-one patients (80%) reached a good outcome; 10 patients (20%) had a poor outcome. Older age, extended hospital stay, memory deficits, decreased consciousness, central hypoventilation, complications and abnormal cerebrospinal fluid results were associated with poor outcome (P < 0.05).

CONCLUSIONS

Female patients more frequently initially present with psychiatric disorder but male patients more frequently initially present with seizure. Patients with anti-NMDAR encephalitis in China have a lower incidence of neoplasm. Nevertheless, this study reveals several challenges in treating anti-NMDAR encephalitis in China that may contribute to poor outcome.

Long-term effects of ageing and ovariectomy on aversive and recognition memory and DNA damage in the hippocampus of female rats

OBJECTIVE

This study investigated the influence of ageing - in particular the decrease of gonadal hormone levels during the ageing process - on the memory and the levels of DNA damage in the hippocampus of female rats.

METHODS

Three groups of female Wistar rats were investigated: Group I consisted of non-ovariectomised, adult animals (6 months old); Group II consisted of non-ovariectomised, aged animals (18 months old); and Group III consisted of ovariectomised, aged animals (18 months old). The memory of the animals in these groups was examined via novel object recognition and inhibitory avoidance tests. The hippocampus tissue samples of all animals were obtained via biopsy and used to quantify the DNA damage using a Comet Assay.

RESULTS

According to our findings, the process of ageing results in a change during the behavioural tests. To prevent genotoxic damage to the hippocampus caused by the ageing process, lowered hormone levels seem to be part of a protective biochemical mechanism in the body of rats. Animals that were previously submitted to an ovariectomy adapted better to these lower levels of hormones.

CONCLUSION

Our results indicate that ovariectomy can provide beneficial long-term effects on the memory. However, this could be specific to the kind of memory examined, as the aversive memory deficits caused by ageing were not affected by ovariectomy.

The influence of sex hormones on seizures in dogs and humans

Epilepsy is the most common chronic neurological disorder in both humans and dogs. The effect of sex hormones on seizures is well documented in human medicine. Catamenial epilepsy is defined as an increase in frequency and severity of seizures during certain periods of the menstrual cycle. Oestradiol increases seizure activity and progesterone is believed to exhibit a protective effect. The role of androgens is controversial and there is a lack of research focusing on androgens and epilepsy. Indeed, little is known about the influence of sex hormones on epilepsy in dogs. Sterilisation is believed to improve seizure control, but no systematic research has been conducted in this field. This review provides an overview of the current literature on the influence of sex hormones on seizures in humans. The literature on idiopathic epilepsy in dogs was assessed to identify potential risk factors related to sex and sterilisation status. In general, there appears to be an over-representation of male dogs with idiopathic epilepsy but no explanation for this difference in prevalence between sexes has been reported. In addition, no reliable conclusions can be drawn on the effect of sterilisation due to the lack of focused research and robust scientific evidence.

Contribution of estradiol in sex-dependent differences of pentylenetetrazole-induced seizures in rats

In the present study the contribution of estradiol in sex-dependent differences of pentylenetetrazole (PTZ)-induced seizures was investigated in rats. The rats were divided into four groups: 1) sham, 2) ovariectomized (OVX), 3) ovariectomized-estradiol (OVX-Est) and 4) male. The OVX-Est group received estradiol valerate (2 mg/kg; i.m/4 weeks) while, male, sham and OVX groups received vehicle. The animals were injected by PTZ (90 mg/kg). The latencies to minimal clonic seizures (MCS) and generalized tonic-clonic seizures (GTCS), were recorded. Serum 17β-estradiol and testosterone levels were also determined using an Elisa kit. GTCS latency in OVX rats was higher than in sham-operated animals (P < 0.05). MCS and GTCS latency in the male group was significantly higher than in the sham, OVX and OVX-Est groups (P < 0.001 and P < 0.01). There was no significant difference in MCS or GTCS latencies among OVX-Est, sham and OVX groups. Serum 17β-estradiol level in the OVX group was significantly lower than in the sham (P < 0.01) and in the OVX-Est group it was higher than in the sham, OVX and male groups (P < 0.01 and P < 0.001). Serum testosterone level in the male group was significantly higher than in all the other three groups (P < 0.001). It seems that testosterone probably has a more efficient role than estradiol in the gender dependent difference in seizure caused by PTZ in rats.

Neurosteroid 3α-androstanediol efficiently counteracts paclitaxel-induced peripheral neuropathy and painful symptoms

Painful peripheral neuropathy belongs to major side-effects limiting cancer chemotherapy. Paclitaxel, widely used to treat several cancers, induces neurological symptoms including burning pain, allodynia, hyperalgesia and numbness. Therefore, identification of drugs that may effectively counteract paclitaxel-induced neuropathic symptoms is crucial. Here, we combined histopathological, neurochemical, behavioral and electrophysiological methods to investigate the natural neurosteroid 3α-androstanediol (3α-DIOL) ability to counteract paclitaxel-evoked peripheral nerve tissue damages and neurological symptoms. Prophylactic or corrective 3α-DIOL treatment (4 mg/kg/2days) prevented or suppressed PAC-evoked heat-thermal hyperalgesia, cold-allodynia and mechanical allodynia/hyperalgesia, by reversing to normal, decreased thermal and mechanical pain thresholds of PAC-treated rats. Electrophysiological studies demonstrated that 3α-DIOL restored control values of nerve conduction velocity and action potential peak amplitude significantly altered by PAC-treatment. 3α-DIOL also repaired PAC-induced nerve damages by restoring normal neurofilament-200 level in peripheral axons and control amount of 2’,3’-cyclic-nucleotide-3’-phosphodiesterase in myelin sheaths. Decreased density of intraepidermal nerve fibers evoked by PAC-therapy was also counteracted by 3α-DIOL treatment. More importantly, 3α-DIOL beneficial effects were not sedation-dependent but resulted from its neuroprotective ability, nerve tissue repairing capacity and long-term analgesic action. Altogether, our results showing that 3α-DIOL efficiently counteracted PAC-evoked painful symptoms, also offer interesting possibilities to develop neurosteroid-based strategies against chemotherapy-induced peripheral neuropathy. This article shows that the prophylactic or corrective treatment with 3α-androstanediol prevents or suppresses PAC-evoked painful symptoms and peripheral nerve dysfunctions in rats. The data suggest that 3α-androstanediol-based therapy may constitute an efficient strategy to explore in humans for the eradication of chemotherapy-induced peripheral neuropathy.

Characterization of rabbit morphine 6-dehydrogenase and two NAD(+)-dependent 3α(17β)-hydroxysteroid dehydrogenases

Mammalian morphine 6-dehydrogenase (M6DH)(1) converts morphine into a reactive electrophile, morphinone. M6DH belongs to the aldo-keto reductase (AKR) superfamily, but its endogenous substrates and entire amino acid sequence remain unknown. A recent rabbit genomic sequencing predicts three genes for novel AKRs (1C26, 1C27 and 1C28) that share >87% amino acid sequence identity and are similar to the partial sequence of rabbit liver M6DH. We isolated cDNAs for the three AKRs, and compared the properties of their recombinant enzymes. Like M6DH, only AKR1C26 that shares the highest sequence identity with hepatic M6DH oxidized morphine. The three AKRs showed NAD(+)-dependent dehydrogenase activity towards other non-steroidal alicyclic alcohols and 3α/17β-hydroxy-C(18)/C(19)/C(21)-steroids, and their mRNAs were ubiquitously expressed in rabbit tissues. The kinetic constants for the substrates suggest that at least AKR1C26 and AKR1C28 act as NAD(+)-dependent 3α/17β-hydroxysteroid dehydrogenases. AKR1C27 differed from AKR1C28 in its high K(m) values for the substrates and low sensitivity towards competitive inhibitors (ikarisoside A, hinokitiol, hexestrol and zearalenone), despite their 95% sequence identity. The site-directed mutagenesis of Tyr118 and Phe310 in AKR1C27 to the corresponding residues (Phe and Ile, respectively) in AKR1C28 produced an enzyme that was similar to AKR1C28, suggesting their key roles in ligand binding.

Effects of testosterone on orchiectomy-induced oxidative damage in the rat hippocampus

The aim of this study was to investigate the morphological changes of the hippocampus after orchiectomy and the protective effects of testosterone on these changes. Animals were divided into 3 groups. The rats in group I were used for sham-orchiectomy. Orchiectomy was performed on the rats in group II. The rats in group III were administrated testosterone propionate 0.5mg/kg/day for 30 days after the orchiectomy. Some of the hippocampal tissues were used for determination of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) enzyme activities, and malondialdehyde (MDA) levels. The remaining hippocampal tissue specimens were stained with routine histological methods and examined under the light microscope. Additionally, the samples were immunohistochemically stained by using avidin-biotin-peroxidase for determination of bax immunoreactivity. The SOD and GSH-Px enzyme activities of the hippocampus were decreased, and MDA levels were increased in group II rats compared to the sham-orchiectomy group. In the light microscopic evaluation of the tissue specimens from group II, significant increases were detected in the number of picnotic cells and in bax immunoreactivity compared to the sham-orchiectomy group. However, an increase was observed in activities of SOD and GSH-Px enzymes and a decrease of the MDA levels in animals with orchiectomy, but having externally administered testosterone. It was determined that the increase of bax immunoreactivity and histopathological changes in this group were regressed by testosterone. The results of our study revealed that orchiectomy-induced oxidative damage and morphological changes in the hippocampal tissue were suppressed by testosterone.

Hormonal aspects of epilepsy

The relationships among hormones, epilepsy, and the medications used to treat epilepsy are complex, with tridirectional interactions that affect both men and women in various ways. Abnormalities of baseline endocrine status occur more commonly in people with epilepsy. Abnormalities are most often described for the sex steroid hormone axis, commonly presenting as sexual dysfunction in men and women with epilepsy and lower fertility. Other signs and symptoms in women with epilepsy include menstrual irregularities, premature menopause, and polycystic ovarian syndrome. The evaluation and care of adult patients with epilepsy should include considerations of the common hormonal aberrations that occur in this patient population. Questions about reproductive health disorders, sexual function, symptoms of thyroid disorders, and bone health should be part of the evaluation of all adult patients with epilepsy. Further laboratory or radiologic testing and referral to other specialists to participate in collaborative care may be warranted if underlying disorders are suspected, especially given that many of these hormone abnormalities can result in long-term health risks as well as negatively affect quality of life. AEDs and hormones have a bidirectional interaction that can impair the efficacy of contraceptive hormone treatments and of the AEDs. Endogenous hormones can influence seizure severity and frequency, resulting in catamenial patterns of epilepsy. However, this susceptibility to hormonal influences can be used to develop hormonal strategies to improve seizure control in women with epilepsy with use of cyclic PROG supplementation or alteration of the endogenous hormone release. Additionally, development of the neurosteroid analog ganaxolone provides a novel approach that can potentially be used across both genders and all age groups.

The effect of L-arginine and L-NAME on pentylenetetrazole induced seizures in ovariectomized rats, an in vivo study

The role of ovarian hormones and nitric oxide (NO) on seizure and their interaction have been widely investigated. The present study carried out to evaluate the effect of chronic administration of L-arginine (LA) and L-NAME (LN) on pentylenetetrazole (PTZ) induced epilepsy in ovariectomized (OVX) and naïve female rats. Fourty-eight female rats were randomly divided into six groups (n=8) as follows: (1) sham, (2) ovarectomized (OVX), (3) sham-LA, (4) sham-LN, (5) OVX-LA, and (6) OVX-LN. The animals of sham-LA and OVX-LA received daily injection of 500 mg/kg L-arginine (i.p.) during 4 weeks. Sham-LN and OVX-LN were treated by 10 mg/kg L-NAME (i.p.) daily for 4 weeks. The animals of sham and OVX groups received 1 ml/kg saline (i.p.) instead of L-arginine and L-NAME. The latencies to minimal clonic seizures (MCS) and generalized tonic-clonic seizures (GTCS) after intraperitoneal injection of penetylenetetrazole (PTZ, 90 mg/kg) was recorded and compared between groups. A significant increase in the GTCS, but not MCS, latency was seen in OVX rats in comparison with sham-operated animals. Pretreatment of animals with L-NAME resulted in a significant increase in the GTCS and MCS latencies in sham group while no significant effects were seen in OVX rats. On the contrary, while pretreatment with L-arginine had no effects on MCS and GTCS latencies in sham group, a significant decrease in GTCS latency was observed in OVX rats. It is concluded that ovarian sex hormones affect seizure thresholds induced by PTZ and NO has a role on seizures susceptibility following PTZ administration. This NO effect might be differing in the presence or absence of ovarian hormones, but further investigations need to be done.

Protective actions of sex steroid hormones in Alzheimer's disease

Risk for Alzheimer's disease (AD) is associated with age-related loss of sex steroid hormones in both women and men. In post-menopausal women, the precipitous depletion of estrogens and progestogens is hypothesized to increase susceptibility to AD pathogenesis, a concept largely supported by epidemiological evidence but refuted by some clinical findings. Experimental evidence suggests that estrogens have numerous neuroprotective actions relevant to prevention of AD, in particular promotion of neuron viability and reduction of beta-amyloid accumulation, a critical factor in the initiation and progression of AD. Recent findings suggest neural responsiveness to estrogen can diminish with age, reducing neuroprotective actions of estrogen and, consequently, potentially limiting the utility of hormone therapies in aged women. In addition, estrogen neuroprotective actions are also modulated by progestogens. Specifically, continuous progestogen exposure is associated with inhibition of estrogen actions whereas cyclic delivery of progestogens may enhance neural benefits of estrogen. In recent years, emerging literature has begun to elucidate a parallel relationship of sex steroid hormones and AD risk in men. Normal age-related testosterone loss in men is associated with increased risk to several diseases including AD. Like estrogen, testosterone has been established as an endogenous neuroprotective factor that not only increases neuronal resilience against AD-related insults, but also reduces beta-amyloid accumulation. Androgen neuroprotective effects are mediated both directly by activation of androgen pathways and indirectly by aromatization to estradiol and initiation of protective estrogen signaling mechanisms. The successful use of hormone therapies in aging men and women to delay, prevent, and or treat AD will require additional research to optimize key parameters of hormone therapy and may benefit from the continuing development of selective estrogen and androgen receptor modulators.

Gender-specific psychosocial impact of living with epilepsy

Although many psychosocial issues affect all people living with epilepsy, certain issues either are specific to one gender or have a different prevalence or significance between men and women with epilepsy. Most studies suggest that the incidence of epilepsy is slightly higher in males with epilepsy. Sexual dysfunction is common among men and women with epilepsy and has been related to epilepsy type and treatment. Women living with epilepsy are often prone to increased seizure frequency at certain phases of their menstrual cycles. Hormone replacement therapy in postmenopausal women may worsen seizures. Treatment during pregnancy is often a precarious balancing act between the teratogenic risks of AEDs and the maintenance of maternal seizure control. However, pregnancy registries and other prospective studies have given us invaluable information on how to optimize treatment regimens as well as information about safety of breastfeeding. These gender-specific factors should be a key consideration when counseling and treating patients with epilepsy.

Hormonal influences on seizures: basic neurobiology

There are sex differences and effects of steroid hormones, such as androgens, estrogens, and progestogens, that influence seizures. Androgens exert early organizational and later activational effects that can amplify sex/gender differences in the expression of some seizure disorders. Female-typical sex steroids, such as estrogen (E2) and progestins, can exert acute activational effects to reduce convulsive seizures and these effects are mediated in part by the actions of steroids in the hippocampus. Some of these anticonvulsive effects of sex steroids are related to their formation of ligands which have agonist-like actions at gamma-aminobutyric acid (GABAA) receptors or antagonist actions at glutamatergic receptors. Differences in stress, developmental phase, reproductive status, endocrine status, and treatments, such as anti-epileptic drugs (AEDs), may alter levels of these ligands and/or the function of target sites, which may mitigate differences in sensitivity to, and/or tolerance of, steroids among some individuals. The evidence implicating sex steroids in differences associated with hormonal, reproductive, developmental, stress, seizure type, and/or therapeutics are discussed.

Antiseizure effects of 5*-androstane-3*,7beta-diol may be independent of actions at estrogen receptor beta

Testosterone (T), the principal androgen secreted by the testes, can have antiseizure effects; however, the mechanism(s) underlying this action is not well understood. T is metabolized to dihydrotestosterone (DHT) by the enzyme 5*-reductase. DHT is then converted to 5*-androstane-3*,17beta-diol (3*-diol) by the enzyme 3*-hydroxysteroid dehydrogenase. T and DHT bind with high affinity to intracellular androgen receptors; however, 3*-diol does not. The mnemonic effects of 3*-diol are mediated in part through the beta isoform of estrogen receptors (ERbeta) in the hippocampus. As such, we investigated whether 3*-diol has antiseizure effects in mice that require action at ERbeta. 3*-Diol (2 mg/kg subcutaneously) was administered to wild-type C57/B6 mice and heterozygous and homozygous ERbeta knockout (betaERKO) mice 1 hour prior to administration of pentylenetetrazol (PTZ; 85 mg/kg intraperitoneally). Mice administered 3*-diol had significantly longer latencies to clonic seizure and death and lower seizure scores than did mice administered vehicle. This pattern of effects was observed in wild-type or betaERKO mice. Thus, for these mice, the antiseizure effects of 3*-diol for the chemoconvulsant PTZ occur independent of actions at ERbeta.

Androgen cell signaling pathways involved in neuroprotective actions

As a normal consequence of aging in men, testosterone levels significantly decline in both serum and brain. Age-related testosterone depletion results in increased risk of dysfunction and disease in androgen-responsive tissues, including brain. Recent evidence indicates that one deleterious effect of age-related testosterone loss in men is increased risk for Alzheimer's disease (AD). We discuss recent findings from our laboratory and others that identify androgen actions implicated in protecting the brain against neurodegenerative diseases and begin to define androgen cell signaling pathways that underlie these protective effects. Specifically, we focus on the roles of androgens as (1) endogenous negative regulators of beta-amyloid accumulation, a key event in AD pathogenesis, and (2) neuroprotective factors that utilize rapid non-genomic signaling to inhibit neuronal apoptosis. Continued elucidation of cell signaling pathways that contribute to protective actions of androgens should facilitate the development of targeted therapeutic strategies to combat AD and other age-related neurodegenerative diseases.

Differential Effects of Antiepileptic Drugs on Neuroactive Steroids in Men with Epilepsy

PURPOSE

To compare serum levels of neuroactive steroids among men with epilepsy who take various antiepileptic drugs, untreated men with epilepsy and normal controls (NC).

METHODS

Subjects were 85 men with localization-related epilepsy [unmedicated >6 months (No Rx)-10, carbamazepine (CBZ)-25, phenytoin (PHT)-25, lamotrigine (LTG)-25] and 25 NC. Sexual function scores (S-Score), hormone levels [dehydroepiandrosterone sulfate (DHEAS), bioactive (BA) testosterone (T), estradiol (BAE), and androstanediol (BAL)] and the ratios of inhibitory to excitatory neuroactive metabolites of T, i.e., BAL/BAE, were compared among groups.

RESULTS

S-scores, DHEAS, and bioactive testosterone (BAT) were significantly (p < 0.05) lower and BAL and BAL/BAE were significantly higher among CBZ and PHT groups than among NC and LTG groups. LTG did not differ from NC in any of these measures. BAT correlated significantly with BAL/BAE for PHT (r = 0.44, p = 0.02) and CBZ (r = 0.42, p = 0.03) but not for NC (r = 0.03, p = NS) and LTG (r = 0.06, p = NS) groups.

CONCLUSIONS

In comparison to LTG, enzyme inducing AEDs (CBZ, PHT) are associated with a more favorable neuroactive steroid balance (lower DHEAS and higher BAL/BAE) for seizure management, but at the expense of reduced serum bioavailable testosterone levels and sexual function.

Androgens, aging, and Alzheimer's disease

Testosterone depletion is a normal consequence of aging in men that is associated with senescent effects in androgen- responsive tissues. We discuss new evidence that one consequence of testosterone depletion in men is an increased risk for the development of Alzheimer's disease (AD). Furthermore, we discuss two candidate mechanisms by which testosterone may affect AD pathogenesis. First, testosterone has been identified as an endogenous regulator of beta-amyloid, a protein that abnormally accumulates in AD brain and is implicated as a causal factor in the disease. Second, findings from several different paradigms indicate that testosterone has both neurotrophic and neuroprotective functions. These new findings support the clinical evaluation of androgen-based therapies for the prevention and treatment of AD.

Morbidity and mortality in patients testing positively for the presence of anabolic androgenic steroids in connection with receiving medical care. A controlled retrospective cohort study

Observations by health-care professionals suggest that the use of anabolic androgenic steroids (AAS) may be associated with lethal complications, but this has not yet been confirmed by controlled epidemiological studies. Here, we investigated the diagnoses (in the Swedish patient care records) and mortality rate among patients who tested positively for the presence of AAS (n = 248) in connection with receiving medical care. Patients who had tested negatively (n = 1215) were used for comparison. The proportions of patients who had received institutionalized care for substance abuse, psychiatric disorder or central thoracic pain were significantly higher in the AAS-positive subjects (RR = 2.2, 95% CI = 1.2-4.2; RR = 2.1, 95% CI = 1.4-3.2 and RR = 3.5, 95% CI = 1.1-10.9, respectively). Furthermore, unspecified convulsions were highly over-represented in the AAS-positive group (RR = 53.9, 95% CI = 7.0-415.7) and one of these patients died during a seizure. The standardized mortality ratios (SMR) in the AAS-positive patients and -negative patients were 20.43 (95% CI = 10.56-35.70) and 6.02 (95% CI = 3.77-9.12), respectively. The relatively higher SMR in the AAS-positive patients was observed irrespective of what type clinic had referred the patients for AAS testing. In conclusion, use of AAS appears to be an indicator of increased risk for premature death in several categories of patients. However, the nature of the association between AAS and premature death remains unclear and additional research on this question is urgently required.

A testosterone metabolite is rewarding to ovariectomized female rats

Anabolic androgenic steroids have become a major class of drugs of abuse among a growing population of male and female adolescents. Although the rewarding and reinforcing properties of androgens have been demonstrated in male rodents, it is unknown whether these properties are apparent in female rats. In this study, conditioned place preference and self-administration paradigms showed that the endogenous androgen metabolite 3alphaDIOL is rewarding and reinforcing in ovariectomized female rats. Because 3alphaDIOL can be synthesized de novo in the brain, it is hypothesized that this neurosteroid provides a permissive neurochemical environment that modulates reward processes.

Ketogenic diet decreases circulating concentrations of neuroactive steroids of female rats

Ketogenic diet (KD) is used to manage intractable epilepsy; however, the mechanisms underlying its therapeutic effects are not known. Steroid hormones, such as progesterone and testosterone, are derived from cholesterol, and are readily 5alpha-reduced to dihydroprogesterone and dihydrotestosterone, which are subsequently converted to 5alpha-pregnan-3alpha-ol-20-one (3alpha,5alpha-THP) and 3alpha-androstanediol, neuroactive steroids that can influence seizures. The present study examined the effects of the KD on circulating concentrations of these neuroactive steroids, and their precursors, in intact female rats. Thirty-six, 22-day-old female Sprague-Dawley rats (weaned at 21 days) were fasted for 8 hours prior to placement on one of three dietary regimens for 6 weeks: ad libitum chow, calorie-restricted chow, or KD. After 6 weeks of the diet, when six rats in each dietary condition were in diestrus and six were in behavioral estrus, all rats were administered pentylenetetrazole (PTZ, 70 mg/kg, i.p.). The latency and incidence of seizures were recorded by an observer who was uninformed of the estrous cycle and dietary treatment conditions of the rats. Immediately after each test, trunk blood was obtained for later measurement of pregnane (progesterone, dihydroprogesterone, 3alpha,5alpha-THP) and androstane (testosterone, dihydrotestosterone, 3alpha-androstanediol) neuroactive steroid concentrations in plasma by radioimmunoassay. KD tended to lengthen the latency to, and significantly reduced the number of, PTZ-induced barrel roll seizures. KD also significantly reduced plasma levels of the pregnane (dihydroprogesterone, 3alpha,5alpha-THP) and androstane (dihydrotestosterone, 3alpha-androstanediol) 5alpha-reduced metabolites. These data suggest that levels of pregnane and androstane neuroactive steroids, or their precursors, may underlie some of the antiseizure effects of KD.

Testosterone's anti-anxiety and analgesic effects may be due in part to actions of its 5alpha-reduced metabolites in the hippocampus

Although testosterone (T) may have effects to enhance analgesia and reduce anxiety, its effects and mechanisms are not well understood. We hypothesized that if T's anti-anxiety and analgesic effects are due in part to actions of its 5alpha-reduced metabolite (dihydrotestosterone-DHT) and/or its 3alpha-hydroxysteroid dehydrogenase reduced metabolite (3alpha-androstanediol-3alpha-diol), in the hippocampus, then androgen regimens that increase levels of these metabolites in the hippocampus should produce anti-anxiety behavior, and analgesic effects, in gonadectomized (GDX) male rats. In Experiment 1, GDX rats were administered T, DHT, 3alpha-diol (1 mg/kg, SC), or vehicle. In Experiment 2, GDX rats had T, DHT, 3alpha-diol-containing inserts, or empty control inserts applied to the dorsal hippocampus immediately prior to behavioral testing. Androgen-administered rats (SC or intrahippocampal) showed significantly more exploratory behavior in the open field and elevated plus maze, less freezing in response to shock, and longer tailflick and pawlick latencies. These findings suggest that T's anti-anxiety effects may be due in part to actions of its 5alpha-reduced metabolites in the dorsal hippocampus.

Sexual hormones and epilepsy: threat and opportunities

PURPOSE OF REVIEW

This article reviews recent developments in our knowledge of the reciprocal interactions between epilepsy and sex hormones and how these interactions may play a role in the pathophysiology and treatment of both.

RECENT FINDINGS

Community studies confirm that menstrual disorders are overrepresented among women with epilepsy, especially among women with high seizure frequency and in those on valproate or polytherapy. Reproductive function is not affected in women with epilepsy who discontinued antiepileptic drug therapy during pubertal maturation. While valproate has been implicated as having particularly notable disruptive effects on reproductive function in women with epilepsy (polycystic ovaries and hyperandrogenemia), this was not evident in non-epileptic primates. The role of epilepsy itself is evident from a study that showed that the laterality of unilateral temporolimbic discharges is associated with predictable directional changes in hormonal secretion at all levels of the reproductive neuroendocrine axis. Epilepsy in men is associated with reduced levels of sexual function, bioactive testosterone and sperm. Various antiepileptic drugs may differ in this regard.

SUMMARY

Epilepsy and antiepileptic drugs can alter sex hormone levels to promote the development of reproductive endocrine disorders in both women and men. Reproductive endocrine disorders may adversely affect both reproductive function and seizure control. Treatment of epilepsy and selection of antiepileptic drugs may be important to reproductive health in women and men with epilepsy. Sex steroids and their metabolites may also provide treatment for seizures.

Testosterone's metabolism in the hippocampus may mediate its anti-anxiety effects in male rats

Androgens may mediate anxiety behaviors; however, these effects and mechanisms of androgens are not well understood. The following experiments investigated whether testosterone (T)'s effects on anxiety behavior are mediated by its 5alpha-reduced, nonaromatizable metabolite dihydrotestosterone (DHT) and/or its 3alpha-hydroxysteroid dehydrogenase (3alpha-HSD) reduced metabolite 3alpha-androstanediol (3alpha-diol). In Experiment 1, gonadally-intact adult male rats and gonadectomized (GDX), DHT-replaced rats had similar low levels of anxiety behavior in the open field and elevated plus maze and fear behavior in the defensive freezing task compared with GDX control rats. In Experiment 2, intact or DHT-replaced rats that received blank inserts to the hippocampus demonstrated less anxiety behavior than did rats administered an implant of indomethacin, a 3alpha-HSD inhibitor, to the dorsal hippocampus. These data indicate that T's 5alpha-reduced metabolite, DHT, can reduce anxiety behavior and that blocking metabolism to 3alpha-diol in the hippocampus can attenuate these effects.

Progestins in the hippocampus of female rats have antiseizure effects in a pentylenetetrazole seizure model

PURPOSE

Progestins can have profound effects on seizure processes. However, the effects and mechanisms of progestins to modulate seizures have not been systematically investigated. The present studies were designed to characterize the effects of progestins to modulate pentylenetetrazole (PTZ)-induced seizures in female rats.

METHODS

In Experiment 1, ictal activity and plasma and hippocampal progesterone (P) and 5alpha-pregnan-3alpha-ol-20-one (3alpha,5alpha-THP) levels of proestrous rats were compared with those of diestrous and ovariectomized (ovx) rats. Experiments 2 and 3 examined effects of ovx and replacement with vehicle, P, or 3alpha,5alpha-THP, systemically (Experiment 2) or to the hippocampus (Experiment 3) on seizures and plasma and hippocampal P and 3alpha,5alpha-THP concentrations.

RESULTS

Proestrous rats had reduced ictal activity and increased levels of P and 3alpha,5alpha-THP in plasma and hippocampus compared with diestrous or ovx rats (Experiment 1). Rats administered systemic P or 3alpha,5alpha-THP had significantly reduced ictal activity and increased plasma and hippocampal P and 3alpha,5alpha-THP levels compared with vehicle-administered rats (Experiment 2). Administration of P or 3alpha,5alpha-THP to the hippocampus of ovx rats significantly reduced seizure activity and increased hippocampal, but not plasma, levels of P and 3alpha,5alpha-THP compared with vehicle administration (Experiment 3).

CONCLUSIONS

Together, these data suggest that P can have antiseizure effects, and these effects may be due in part to actions of its metabolite, 3alpha,5alpha-THP, in the hippocampus.

Mnemonic effects of testosterone and its 5α-reduced metabolites in the conditioned fear and inhibitory avoidance tasks

Experiments were conducted to examine whether performance in hippocampally-mediated learning tasks is influenced by testosterone (T) and/or its 5alpha-reduced metabolites, dihydrotestosterone (DHT) and 3alpha-androstanediol (3alpha-diol). Performance in the conditioned fear and inhibitory avoidance tasks were examined in intact and gonadectomized (GDX), androgen-replaced rats. In Experiment 1, the behavior of intact and GDX rats in the conditioned fear paradigm were compared. GDX rats spent more time freezing, an index of increased learning, in the context, hippocampally-mediated task, but not in the cued, amygdala-mediated task. In Experiment 2, GDX rats were administered T, DHT, 3alpha-diol, estrogen (E2), or vehicle 1 mg/kg sc after training in the conditioned fear paradigm. T-, 3alpha-diol-, or E2-, compared with vehicle-administered rats, spent significantly more time freezing in the contextual, but not the cued, condition. In Experiment 3, intact compared with GDX rats had significantly longer crossover latencies, indicating better performance, in the inhibitory avoidance task. In Experiment 4, T, DHT, 3alpha-diol, or vehicle 1 mg/kg sc was administered to GDX rats immediately following training in the inhibitory avoidance task. Rats administered T, DHT, or 3alpha-diol had significantly longer crossover latencies compared with vehicle controls. In Experiment 5, androgen levels in the hippocampus were elevated 1 h following administration, when androgen exposure is essential for consolidation. These data indicate that androgens effects to enhance learning may be mediated in part by actions of 5alpha-reduced metabolites in the hippocampus.