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Karimi-Rouzbahani H, McGonigal A. Generalisability of epileptiform patterns across time and patients. Sci Rep 2024; 14:6293. [PMID: 38491096 PMCID: PMC10942983 DOI: 10.1038/s41598-024-56990-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 03/13/2024] [Indexed: 03/18/2024] Open
Abstract
The complexity of localising the epileptogenic zone (EZ) contributes to surgical resection failures in achieving seizure freedom. The distinct patterns of epileptiform activity during interictal and ictal phases, varying across patients, often lead to suboptimal localisation using electroencephalography (EEG) features. We posed two key questions: whether neural signals reflecting epileptogenicity generalise from interictal to ictal time windows within each patient, and whether epileptiform patterns generalise across patients. Utilising an intracranial EEG dataset from 55 patients, we extracted a large battery of simple to complex features from stereo-EEG (SEEG) and electrocorticographic (ECoG) neural signals during interictal and ictal windows. Our features (n = 34) quantified many aspects of the signals including statistical moments, complexities, frequency-domain and cross-channel network attributes. Decision tree classifiers were then trained and tested on distinct time windows and patients to evaluate the generalisability of epileptogenic patterns across time and patients, respectively. Evidence strongly supported generalisability from interictal to ictal time windows across patients, particularly in signal power and high-frequency network-based features. Consistent patterns of epileptogenicity were observed across time windows within most patients, and signal features of epileptogenic regions generalised across patients, with higher generalisability in the ictal window. Signal complexity features were particularly contributory in cross-patient generalisation across patients. These findings offer insights into generalisable features of epileptic neural activity across time and patients, with implications for future automated approaches to supplement other EZ localisation methods.
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Affiliation(s)
- Hamid Karimi-Rouzbahani
- Neurosciences Centre, Mater Hospital, South Brisbane, 4101, Australia.
- Mater Research Institute, University of Queensland, South Brisbane, 4101, Australia.
- Queensland Brain Institute, University of Queensland, St Lucia, 4072, Australia.
| | - Aileen McGonigal
- Neurosciences Centre, Mater Hospital, South Brisbane, 4101, Australia
- Mater Research Institute, University of Queensland, South Brisbane, 4101, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, 4072, Australia
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2
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Lu Y, Lin M, Ou S, Sun L, Qian K, Kuang H, Wu Y. Astragalus polysaccharides ameliorate epileptogenesis, cognitive impairment, and neuroinflammation in a pentylenetetrazole-induced kindling mouse model. Front Pharmacol 2024; 15:1336122. [PMID: 38405667 PMCID: PMC10884767 DOI: 10.3389/fphar.2024.1336122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/31/2024] [Indexed: 02/27/2024] Open
Abstract
Background: Epilepsy is a prevalent neurological disease where neuroinflammation plays a significant role in epileptogenesis. Recent studies have suggested that Astragalus polysaccharides (APS) have anti-inflammatory properties, which make them a potential candidate for neuroprotection against central nervous system disease. Nevertheless, the extent of their effectiveness in treating epilepsy remains enigmatic. Therefore, our study aims to investigate the potential of APS to mitigate epileptogenesis and its comorbidities by exploring its underlying mechanism. Methods: Initially, we employed pentylenetetrazol-induced seizure mice to validate APS' effectiveness. Subsequently, we employed network pharmacology analysis to probe the possible targets and signaling pathways of APS in treating epilepsy. Ultimately, we verified the key targets and signaling pathways experimentally, predicting their mechanisms of action. Results: APS have been observed to disturb the acquisition process of kindling, leading to reduced seizure scores and a lower incidence of complete kindling. Moreover, APS has been found to improve cognitive impairments and prevent hippocampal neuronal damage during the pentylenetetrazole (PTZ)-kindling process. Subsequent network pharmacology analysis revealed that APS potentially exerted their anti-epileptic effects by targeting cytokine and toll-like receptor 4/nuclear factor kappa B (TLR4/NF-κB) signaling pathways. Finally, experimental findings showed that APS efficiently inhibited the activation of astrocytes and reduced the release of pro-inflammatory mediators, such as interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α). In addition, APS impeded the activation of the TLR4/NF-κB signaling cascade in a PTZ-induced kindling mouse model. Conclusion: The outcomes of our study suggest that APS exerts an impact on epileptogenesis and mitigates cognitive impairment by impeding neuroinflammatory processes. The mechanism underlying these observations may be attributed to the modulation of the TLR4/NF-κB signaling pathway, resulting in a reduction of the release of inflammatory mediators. These findings partially agree with the predictions derived from network pharmacology analyses. As such, APS represents a potentially innovative and encouraging adjunct therapeutic option for epileptogenesis and cognitive deficit.
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Affiliation(s)
- Yuling Lu
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Minglin Lin
- Department of Colorectal and Anal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Sijie Ou
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Lanfeng Sun
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Kai Qian
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Huimin Kuang
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yuan Wu
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, China
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3
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Milano C, Montali M, Barachini S, Burzi IS, Pratesi F, Petrozzi L, Chico L, Morganti R, Gambino G, Rossi L, Ceravolo R, Siciliano G, Migliorini P, Petrini I, Pizzanelli C. Increased production of inflammatory cytokines by circulating monocytes in mesial temporal lobe epilepsy: A possible role in drug resistance. J Neuroimmunol 2024; 386:578272. [PMID: 38160122 DOI: 10.1016/j.jneuroim.2023.578272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/05/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
We analyzed peripheral blood mononuclear cells (PBMCs) and serum inflammatory biomarkers in patients with mesial temporal lobe epilepsy (drug-resistant - DR, vs. drug-sensitive - DS). Patients with epilepsy showed higher levels of serum CCL2, CCL3, IL-8 and AOPP, and lower levels of FRAP and thiols compared to healthy controls (HC). Although none of the serum biomarkers distinguished DR from DS patients, when analysing intracellular cytokines after in vitro stimulation, DR patients presented higher percentages of IL-1β and IL-6 positive monocytes compared to DS patients and HC. Circulating innate immune cells might be implicated in DR epilepsy and constitute potential new targets for treatments.
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Affiliation(s)
- C Milano
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy.
| | - M Montali
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - S Barachini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I S Burzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - F Pratesi
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - L Petrozzi
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - L Chico
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - R Morganti
- Section of Statistics, University of Pisa, Pisa, Italy
| | - G Gambino
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Rossi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - R Ceravolo
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - G Siciliano
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - P Migliorini
- Department of Clinical and Experimental Medicine, Clinical Immunology and Allergy Unit, University of Pisa, Pisa, Italy
| | - I Petrini
- Department of Translational Research and New Technology in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - C Pizzanelli
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy.
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4
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Vitale G, Terrone G, Vitale S, Vitulli F, Aiello S, Bravaccio C, Pisano S, Bove I, Rizzo F, Seetahal-Maraj P, Wiese T. The Evolving Landscape of Therapeutics for Epilepsy in Tuberous Sclerosis Complex. Biomedicines 2023; 11:3241. [PMID: 38137462 PMCID: PMC10741146 DOI: 10.3390/biomedicines11123241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/30/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare multisystem genetic disorder characterized by benign tumor growth in multiple organs, including the brain, kidneys, heart, eyes, lungs, and skin. Pathogenesis stems from mutations in either the TSC1 or TSC2 gene, which encode the proteins hamartin and tuberin, respectively. These proteins form a complex that inhibits the mTOR pathway, a critical regulator of cell growth and proliferation. Disruption of the tuberin-hamartin complex leads to overactivation of mTOR signaling and uncontrolled cell growth, resulting in hamartoma formation. Neurological manifestations are common in TSC, with epilepsy developing in up to 90% of patients. Seizures tend to be refractory to medical treatment with anti-seizure medications. Infantile spasms and focal seizures are the predominant seizure types, often arising in early childhood. Drug-resistant epilepsy contributes significantly to morbidity and mortality. This review provides a comprehensive overview of the current state of knowledge regarding the pathogenesis, clinical manifestations, and treatment approaches for epilepsy and other neurological features of TSC. While narrative reviews on TSC exist, this review uniquely synthesizes key advancements across the areas of TSC neuropathology, conventional and emerging pharmacological therapies, and targeted treatments. The review is narrative in nature, without any date restrictions, and summarizes the most relevant literature on the neurological aspects and management of TSC. By consolidating the current understanding of TSC neurobiology and evidence-based treatment strategies, this review provides an invaluable reference that highlights progress made while also emphasizing areas requiring further research to optimize care and outcomes for TSC patients.
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Affiliation(s)
- Giovanni Vitale
- Neuroscience and Rare Diseases, Discovery and Translational Area, Roche Pharma Research and Early Development (pRED), F. Hoffmann–La Roche, 4070 Basel, Switzerland
| | - Gaetano Terrone
- Department of Translational Medical Sciences, Child and Adolescent Neuropsychiatry, University of Naples Federico II, 80138 Naples, Italy; (G.T.); (C.B.)
| | - Samuel Vitale
- School of Medicine and Surgery, University of Naples Federico II, 80138 Naples, Italy;
| | - Francesca Vitulli
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, University of Naples Federico II, 80138 Naples, Italy (I.B.)
| | - Salvatore Aiello
- Department of Translational Medical Sciences, Child and Adolescent Neuropsychiatry, University of Naples Federico II, 80138 Naples, Italy; (G.T.); (C.B.)
| | - Carmela Bravaccio
- Department of Translational Medical Sciences, Child and Adolescent Neuropsychiatry, University of Naples Federico II, 80138 Naples, Italy; (G.T.); (C.B.)
| | - Simone Pisano
- Department of Translational Medical Sciences, Child and Adolescent Neuropsychiatry, University of Naples Federico II, 80138 Naples, Italy; (G.T.); (C.B.)
| | - Ilaria Bove
- Department of Neurosciences and Reproductive and Dental Sciences, Division of Neurosurgery, University of Naples Federico II, 80138 Naples, Italy (I.B.)
| | - Francesca Rizzo
- Department of Neuroscience “Rita Levi Montalcini”, University of Turin, 10126 Turin, Italy;
| | | | - Thomas Wiese
- Neuroscience and Rare Diseases, Discovery and Translational Area, Roche Pharma Research and Early Development (pRED), F. Hoffmann–La Roche, 4070 Basel, Switzerland
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Jhaveri DJ, McGonigal A, Becker C, Benoliel JJ, Nandam LS, Soncin L, Kotwas I, Bernard C, Bartolomei F. Stress and Epilepsy: Towards Understanding of Neurobiological Mechanisms for Better Management. eNeuro 2023; 10:ENEURO.0200-23.2023. [PMID: 37923391 PMCID: PMC10626502 DOI: 10.1523/eneuro.0200-23.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/03/2023] [Accepted: 09/20/2023] [Indexed: 11/07/2023] Open
Abstract
Stress has been identified as a major contributor to human disease and is postulated to play a substantial role in epileptogenesis. In a significant proportion of individuals with epilepsy, sensitivity to stressful events contributes to dynamic symptomatic burden, notably seizure occurrence and frequency, and presence and severity of psychiatric comorbidities [anxiety, depression, posttraumatic stress disorder (PTSD)]. Here, we review this complex relationship between stress and epilepsy using clinical data and highlight key neurobiological mechanisms including the hypothalamic-pituitary-adrenal (HPA) axis dysfunction, altered neuroplasticity within limbic system structures, and alterations in neurochemical pathways such as brain-derived neurotrophic factor (BNDF) linking epilepsy and stress. We discuss current clinical management approaches of stress that help optimize seizure control and prevention, as well as psychiatric comorbidities associated with epilepsy. We propose that various shared mechanisms of stress and epilepsy present multiple avenues for the development of new symptomatic and preventative treatments, including disease modifying therapies aimed at reducing epileptogenesis. This would require close collaborations between clinicians and basic scientists to integrate data across multiple scales, from genetics to systems biology, from clinical observations to fundamental mechanistic insights. In future, advances in machine learning approaches and neuromodulation strategies will enable personalized and targeted interventions to manage and ultimately treat stress-related epileptogenesis.
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Affiliation(s)
- Dhanisha J Jhaveri
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4067, Australia
| | - Aileen McGonigal
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD 4067, Australia
- Mater Epilepsy Unit, Department of Neurosciences, Mater Hospital, Brisbane, QLD 4101, Australia
| | - Christel Becker
- Institut National de la Santé et de la Recherche Médicale, Unité 1124, Université Paris Cité, Paris, 75006, France
| | - Jean-Jacques Benoliel
- Institut National de la Santé et de la Recherche Médicale, Unité 1124, Université Paris Cité, Paris, 75006, France
- Site Pitié-Salpêtrière, Service de Biochimie Endocrinienne et Oncologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, 75651, France
| | - L Sanjay Nandam
- Turner Inst for Brain & Mental Health, Faculty of Medicine, Nursing and Health Sciences, School of Psychological Sciences, Monash University, Melbourne, 3800, Australia
| | - Lisa Soncin
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, 13005, France
- Laboratoire d'Anthropologie et de Psychologie Cliniques, Cognitives et Sociales, Côte d'Azur University, Nice, 06300, France
| | - Iliana Kotwas
- Epileptology and Cerebral Rhythmology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Marseille, 13005, France
| | - Christophe Bernard
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, 13005, France
| | - Fabrice Bartolomei
- Institut National de la Santé et de la Recherche Médicale, Institut de Neurosciences des Systèmes, Aix Marseille University, Marseille, 13005, France
- Epileptology and Cerebral Rhythmology, Assistance Publique Hôpitaux de Marseille, Timone Hospital, Marseille, 13005, France
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6
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Wang Y, Zhuo Z, Wang H. Epilepsy, gut microbiota, and circadian rhythm. Front Neurol 2023; 14:1157358. [PMID: 37273718 PMCID: PMC10232836 DOI: 10.3389/fneur.2023.1157358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/24/2023] [Indexed: 06/06/2023] Open
Abstract
In recent years, relevant studies have found changes in gut microbiota (GM) in patients with epilepsy. In addition, impaired sleep and circadian patterns are common symptoms of epilepsy. Moreover, the types of seizures have a circadian rhythm. Numerous reports have indicated that the GM and its metabolites have circadian rhythms. This review will describe changes in the GM in clinical and animal studies under epilepsy and circadian rhythm disorder, respectively. The aim is to determine the commonalities and specificities of alterations in GM and their impact on disease occurrence in the context of epilepsy and circadian disruption. Although clinical studies are influenced by many factors, the results suggest that there are some commonalities in the changes of GM. Finally, we discuss the links among epilepsy, gut microbiome, and circadian rhythms, as well as future research that needs to be conducted.
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Affiliation(s)
- Yao Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhihong Zhuo
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Key Laboratory of Childhood Epilepsy and Immunology, Zhengzhou, China
- Henan Provincial Children's Neurological Disease Clinical Diagnosis and Treatment Center, Zhengzhou, China
| | - Huaili Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Key Laboratory of Childhood Epilepsy and Immunology, Zhengzhou, China
- Henan Provincial Children's Neurological Disease Clinical Diagnosis and Treatment Center, Zhengzhou, China
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7
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Gao F, Chen R, Li S, Li A, Bai B, Mi R, Xue G. (+)-Borneol exerts neuroprotective effects via suppressing the NF-κB pathway in the pilocarpine-induced epileptogenesis rat model. Brain Res 2023; 1810:148382. [PMID: 37127175 DOI: 10.1016/j.brainres.2023.148382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023]
Abstract
Neuroinflammation plays a crucial role in the development of epilepsy, and suppressing neuroinflammation can delay epileptogenesis. Recent reports have demonstrated that (+)-borneol has neuroprotective effects in several brain disorders by reducing neuroinflammation. However, its effects on epilepsy have not been reported. In this research, we first studied the effect of different doses of (+)-borneol (3, 6, and 12 mg/kg) on neuroinflammation in a pilocarpine model of epileptogenesis by detecting IL-1β, TNF-α, and COX-2 expression. We demonstrated that different doses of (+)-borneol decreased IL-1β, TNF-α, and COX-2 levels, with 12 mg/kg having the most substantial effect. Furthermore, we examined the effects of 12 mg/kg (+)-borneol on neuronal damage, glial cell activation, and apoptosis in the hippocampus at different time points (1, 3, and 7 days) after SE. We found that (+)-borneol significantly ameliorated neuronal injury, decreased glial cell activation, and attenuated apoptosis. We also found that (+)-borneol inhibited the NF-κB pathway activation induced by SE. In conclusion, our results indicated that (+)-borneol reduces neuroinflammation by inhibiting the NF-κB pathway activation, exerts neuroprotective effects, and may have an inhibitory effect in epileptogenesis.
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Affiliation(s)
- Fankai Gao
- Department of Neurology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi Province, China
| | - Rui Chen
- Department of Neurology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi Province, China
| | - Shuo Li
- Department of Neurology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi Province, China
| | - An Li
- Department of Neurology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi Province, China
| | - Bo Bai
- Department of Neurology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi Province, China
| | - Rulin Mi
- Department of Neurology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi Province, China
| | - Guofang Xue
- Department of Neurology, The Second Hospital of Shanxi Medical University, No. 382 Wuyi Road, Taiyuan, 030001, Shanxi Province, China.
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8
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Citraro R, Leo A. Epilepsy and Related Neuropsychiatric Comorbidities: Basic and Clinical Research. Curr Neuropharmacol 2023; 21:1632-1633. [PMID: 37340669 PMCID: PMC10514546 DOI: 10.2174/1570159x2108230510162504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Affiliation(s)
- Rita Citraro
- Science of Health Department, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
| | - Antonio Leo
- Science of Health Department, “Magna Graecia” University of Catanzaro, Catanzaro, Italy
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9
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Pharmacological perspectives and mechanisms involved in epileptogenesis. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2022. [DOI: 10.1186/s43088-022-00278-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Epileptogenesis can be defined as the process by which a previously healthy brain develops a tendency toward recurrent electrical activity, occurring in three phases: first as an initial trigger (such as stroke, infections, and traumatic brain injury); followed by the latency period and the onset of spontaneous and recurrent seizures which characterizes epilepsy.
Main body
The mechanisms that may be involved in epileptogenesis are inflammation, neurogenesis, migration of neurons to different regions of the brain, neural reorganization, and neuroplasticity.In recent years, experimental studies have enabled the discovery of several mechanisms involved in the process of epileptogenesis, mainly neuroinflammation, that involves the activation of glial cells and an increase in specific inflammatory mediators. The lack of an experimental animal model protocol for epileptogenic compounds contributes to the difficulty in understanding disease development and the creation of new drugs.
Conclusion
To solve these difficulties, a new approach is needed in the development of new AEDs that focus on the process of epileptogenesis and the consolidation of animal models for studies of antiepileptogenic compounds, aiming to reach the clinical phases of the study. Some examples of these compounds are rapamycin, which inhibits mTOR signaling, and losartan, that potentiates the antiepileptogenic effect of some AEDs. Based on this, this review discusses the main mechanisms involved in epileptogenesis, as well as its pharmacological approach.
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10
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Swatzyna RJ, Arns M, Tarnow JD, Turner RP, Barr E, MacInerney EK, Hoffman AM, Boutros NN. Isolated epileptiform activity in children and adolescents: prevalence, relevance, and implications for treatment. Eur Child Adolesc Psychiatry 2022; 31:545-552. [PMID: 32666203 DOI: 10.1007/s00787-020-01597-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
In the field of psychiatry diagnoses are primarily based on the report of symptoms from either the patient, parents, or both, and a psychiatrist's observations. A psychiatric diagnosis is currently the most widely used basis for medication selection and the brain is seldom investigated directly as a source of those symptoms. This study addresses the request from the National Institute of Mental Health (NIMH) Research Domain Criteria Project (RDoC) for scientific research into neurological abnormalities that can be linked to psychiatric symptoms for the purpose of predicting medication response. One such neurological abnormality that has been the focus of many studies over the last three decades is isolated epileptiform discharges (IEDs) in children and adolescents without seizures. We conducted a systematic review of the literature to determine prevalence rates of IEDs within diagnostic categories. We then compared the prevalence of IEDs in the selected literature to our IRB-approved data archive. Our study found a consistent high prevalence of IEDs specifically for ADHD (majority > 25%) and ASD (majority > 59%), and consistent low prevalence rates were found for Depression (3%). If children and adolescents have failed multiple medication attempts, and more than one-third of them have IEDs, then an EEG would be justified within the RDoC paradigm.
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Affiliation(s)
- Ronald J Swatzyna
- Houston Neuroscience Brain Center, Houston, TX, USA. .,Clinical NeuroAnalytics, 1307 Oceanside Lane, League City, TX, 77573, USA.
| | - Martijn Arns
- Department of Experimental Psychology, Utrecht University, Utrecht, The Netherlands.,Research Institute Brainclinics, Brainclinics Foundation, Nijmegen, The Netherlands
| | - Jay D Tarnow
- The Tarnow Center for Self-Management, Houston, USA
| | - Robert P Turner
- Network Neurology Health, Charleston, SC, USA.,Clinical Pediatrics and Neurology, USC School of Medicine, Columbia, SC, USA
| | - Emma Barr
- Houston Neuroscience Brain Center, Houston, TX, USA
| | | | | | - Nash N Boutros
- School of Medicine, RUSH University, Kansas City, MO, USA
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11
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Campos-Bedolla P, Feria-Romero I, Orozco-Suárez S. Factors not considered in the study of drug-resistant epilepsy: Drug-resistant epilepsy: assessment of neuroinflammation. Epilepsia Open 2022; 7 Suppl 1:S68-S80. [PMID: 35247028 PMCID: PMC9340302 DOI: 10.1002/epi4.12590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 02/15/2022] [Accepted: 02/27/2022] [Indexed: 11/13/2022] Open
Abstract
More than one‐third of people with epilepsy develop drug‐resistant epilepsy (DRE). Different hypotheses have been proposed to explain the origin of DRE. Accumulating evidence suggests the contribution of neuroinflammation, modifications in the integrity of the blood‐brain barrier (BBB), and altered immune responses in the pathophysiology of DRE. The inflammatory response is mainly due to the increase of cytokines and related molecules; these molecules have neuromodulatory effects that contribute to hyperexcitability in neural networks that cause seizure generation. Some patients with DRE display the presence of autoantibodies in the serum and mainly cerebrospinal fluid. These patients are refractory to the different treatments with standard antiseizure medications (ASMs), and they could be responding well to immunomodulatory therapies. This observation emphasizes that the etiopathogenesis of DRE is involved with immunology responses and associated long‐term events and chronic inflammation processes. Furthermore, multiple studies have shown that functional polymorphisms as risk factors are involved in inflammation processes. Several relevant polymorphisms could be considered risk factors involved in inflammation‐related DRE such as receptor for advanced glycation end products (RAGE) and interleukin 1β (IL‐1β). All these evidences sustained the hypothesis that the chronic inflammation process is associated with the DRE. However, the effect of the chronic inflammation process should be investigated in further clinical studies to promote the development of novel therapeutics useful in treatment of DRE.
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Affiliation(s)
- Patricia Campos-Bedolla
- Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades, "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Iris Feria-Romero
- Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades, "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Sandra Orozco-Suárez
- Unidad de Investigación Médica en Enfermedades Neurológicas, Hospital de Especialidades, "Dr. Bernardo Sepúlveda", Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México
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13
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Lin CH, Hsieh CL. Chinese Herbal Medicine for Treating Epilepsy. Front Neurosci 2021; 15:682821. [PMID: 34276290 PMCID: PMC8284486 DOI: 10.3389/fnins.2021.682821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
Chinese herbal medicine has a long history of use for treating epilepsy. Because of the side effects of Western antiepileptic therapy and the quest for more accessible treatment, complementary and alternative medicines have become popular. Traditional Chinese medical diet therapy appears to be safe and effective. We searched PubMed and the Cochrane Library through November 2020 for the use of traditional Chinese medicine in clinical settings, including plants, fungi, and animals. Combinations of keywords included “epilepsy,” “seizure,” “antiepileptic,” “anticonvulsive,” “Chinese herbal medicine,” “Chinese herb,” and each of the Latin names, English names, and scientific names of herbs. We also summarized the sources and functions of these herbs in Chinese medicine. Different herbs can be combined to increase antiepileptic effects through various mechanisms, including anti-inflammation, antioxidation, GABAergic effect enhancement, modulation of NMDA channels and sodium channel, and neuroprotection. Despite reports of their anticonvulsive effects, adequate experimental evidence and randomized controlled clinical trials are required to confirm their antiepileptic effects.
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Affiliation(s)
- Chia-Hui Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan.,Chinese Medicine Research Center, China Medical University, Taichung, Taiwan.,Graduate Institute of Acupuncture Science, College of Chinese Medicine, China Medical University, Taichung, Taiwan
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14
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Yu N, Lin XJ, Di Q. How to Find Candidate Drug-targets for Antiepileptogenic Therapy? Curr Neuropharmacol 2021; 18:624-635. [PMID: 31989901 PMCID: PMC7457424 DOI: 10.2174/1570159x18666200128124338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 12/10/2019] [Accepted: 01/27/2020] [Indexed: 11/22/2022] Open
Abstract
Although over 25 antiepileptic drugs (AEDs) have become currently available for clinical use, the incidence of epilepsy worldwide and the proportions of drug-resistant epilepsy among them are not significantly reduced during the past decades. Traditional screens for AEDs have been mainly focused on their anti-ictogenic roles, and their efficacies primarily depend on suppressing neuronal excitability or enhancing inhibitory neuronal activity, almost without the influence on the epileptogenesis or with inconsistent results from different studies. Epileptogenesis refers to the pathological process of a brain from its normal status to the alterations with the continuous prone of unprovoked spontaneous seizures after brain insults, such as stroke, traumatic brain injury, CNS infectious, and autoimmune disorders, and even some specific inherited conditions. Recently growing experimental and clinical studies have discovered the underlying mechanisms for epileptogenesis, which are multi-aspect and multistep. These findings provide us a number of interesting sites for antiepileptogenic drugs (AEGDs). AEGDs have been evidenced as significantly roles of postponing or completely blocking the development of epilepsy in experimental models. The present review will introduce potential novel candidate drug-targets for AEGDs based on the published studies.
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Affiliation(s)
- Nian Yu
- Department of Neurology, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, 210029, Nanjing, China
| | - Xing-Jian Lin
- Department of Neurology, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, 210029, Nanjing, China
| | - Qing Di
- Department of Neurology, The Affiliated Nanjing Brain Hospital of Nanjing Medical University, 210029, Nanjing, China
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15
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Koh S, Wirrell E, Vezzani A, Nabbout R, Muscal E, Kaliakatsos M, Wickström R, Riviello JJ, Brunklaus A, Payne E, Valentin A, Wells E, Carpenter JL, Lee K, Lai Y, Eschbach K, Press CA, Gorman M, Stredny CM, Roche W, Mangum T. Proposal to optimize evaluation and treatment of Febrile infection-related epilepsy syndrome (FIRES): A Report from FIRES workshop. Epilepsia Open 2021; 6:62-72. [PMID: 33681649 PMCID: PMC7918329 DOI: 10.1002/epi4.12447] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/23/2022] Open
Abstract
Febrile infection-related epilepsy syndrome (FIRES) is a rare catastrophic epileptic encephalopathy that presents suddenly in otherwise normal children and young adults causing significant neurological disability, chronic epilepsy, and high rates of mortality. To suggest a therapy protocol to improve outcome of FIRES, workshops were held in conjunction with American Epilepsy Society annual meeting between 2017 and 2019. An international group of pediatric epileptologists, pediatric neurointensivists, rheumatologists and basic scientists with interest and expertise in FIRES convened to propose an algorithm for a standardized approach to the diagnosis and treatment of FIRES. The broad differential for refractory status epilepticus (RSE) should include FIRES, to allow empiric therapies to be started early in the clinical course. FIRES should be considered in all previously healthy patients older than two years of age who present with explosive onset of seizures rapidly progressing to RSE, following a febrile illness in the preceding two weeks. Once FIRES is suspected, early administrations of ketogenic diet and anakinra (the IL-1 receptor antagonist that blocks biologic activity of IL-1β) are recommended.
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Affiliation(s)
- Sookyong Koh
- Department of PediatricsEmory University School of MedicineAtlantaGAUSA
| | - Elaine Wirrell
- Child and Adolescent Neurology and EpilepsyMayo ClinicRochesterMNUSA
| | - Annamaria Vezzani
- Department of NeuroscienceInstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - Rima Nabbout
- Reference Centre for Rare EpilepsiesDepartment of Pediatric NeurologyNecker Enfants Malades Hospital, APHPImagine InstituteParis Descartes UniversityParisFrance
| | - Eyal Muscal
- Department of PediatricsSection of Pediatric, RheumatologyBaylor College of MedicineHoustonTXUSA
| | - Marios Kaliakatsos
- Department of NeurologyGreat Ormond Street Hospital for ChildrenLondonUK
| | - Ronny Wickström
- Neuropediatric UnitDepartment of Women's and Children's HealthKarolinska InstituteStockholmSweden
| | | | - Andreas Brunklaus
- Paediatric Neurosciences Research GroupRoyal Hospital for ChildrenGlasgowUK
| | - Eric Payne
- Child and Adolescent Neurology and EpilepsyMayo ClinicRochesterMNUSA
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, Psychology and NeuroscienceDepartment of Clinical NeurophysiologyKing's College Hospital NHS TrustLondonUK
| | - Elizabeth Wells
- Center for Neuroscience and Behavioral MedicineChildren’s National Health SystemWashingtonDCUSA
| | - Jessica L. Carpenter
- Center for Neuroscience and Behavioral MedicineChildren’s National Health SystemWashingtonDCUSA
| | - Kihyeong Lee
- Comprehensive Epilepsy CenterAdvent Health for ChildrenOrlandoFLUSA
| | - Yi‐Chen Lai
- Jan and Dan Duncan Neurological Research InstituteBaylor College of MedicineHoustonTXUSA
| | - Krista Eschbach
- Department of PediatricsSection of NeurologyUniversity of Colorado DenverDenverCOUSA
| | - Craig A. Press
- Department of PediatricsSection of NeurologyUniversity of Colorado DenverDenverCOUSA
| | - Mark Gorman
- Department of NeurologyBoston Children’s HospitalBostonMAUSA
| | | | - William Roche
- Department of PediatricsEmory University School of MedicineAtlantaGAUSA
| | - Tara Mangum
- Department of PediatricsPhoenix Children’s HospitalPhoenixAZUSA
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16
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Vega-García A, Rocha L, Guevara-Guzmán R, Guerra-Araiza C, Feria-Romero I, Gallardo JM, Neri-Gomez T, Suárez-Santiago JE, Orozco-Suarez S. Magnolia officinalis Reduces Inflammation and Damage Induced by Recurrent Status Epilepticus in Immature Rats. Curr Pharm Des 2020; 26:1388-1401. [PMID: 32196444 DOI: 10.2174/1381612826666200320121813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/27/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Neuroinflammation induced in response to damage caused by status epilepticus (SE) activates the interleukin (IL)1-β pathway and proinflammatory proteins that increase vulnerability to the development of spontaneous seizure activity and/or epilepsy. OBJECTIVES The study aimed to assess the short-term anti-inflammatory and neuroprotective effects of Magnolia officinalis (MO) on recurrent SE in immature rats. METHODS Sprague-Dawley rats at PN day 10 were used; n = 60 rats were divided into two control groups, SHAM and KA, and two experimental groups, MO (KA-MO) and Celecoxib (KA-Clbx). The anti-inflammatory effect of a single dose of MO was evaluated at 6 and 24 hr by Western blotting and on day 30 PN via a subchronic administration of MO to assess neuronal preservation and hippocampal gliosis by immunohistochemistry for NeunN and GFAP, respectively. RESULTS KA-MO caused a decrease in the expression of IL1-β and Cox-2 at 6 and 24 h post-treatment, a reduction in iNOS synthase at 6 and 24 hr post-treatment and reduced neuronal loss and gliosis at postnatal day 30, similar to Clbx. CONCLUSION The results indicating that Magnolia officinalis is an alternative preventive treatment for early stages of epileptogenesis are encouraging.
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Affiliation(s)
- Angélica Vega-García
- Unidad de Investigacion Medica en Enfermedades Neurologicas, Hospital de Especialidades, "Dr. Bernardo Sepulveda", Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, IMSS, Ciudad de Mexico, Mexico.,Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico
| | - Luisa Rocha
- Departamento de Farmacobiologia, Centro de Investigacion y Estudios Avanzados, Tlalpan, Ciudad de Mexico, Mexico
| | - Rosalinda Guevara-Guzmán
- Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico
| | - Christian Guerra-Araiza
- Unidad de Investigacion Medica en Farmacologia, Hospital de Especialidades, "Dr. Bernardo Sepulveda", Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, IMSS, Ciudad de Mexico, Mexico
| | - Iris Feria-Romero
- Unidad de Investigacion Medica en Enfermedades Neurologicas, Hospital de Especialidades, "Dr. Bernardo Sepulveda", Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, IMSS, Ciudad de Mexico, Mexico
| | - Juan M Gallardo
- Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, "Dr. Bernardo Sepulveda", Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, IMSS, Ciudad de Mexico, Mexico
| | - Teresa Neri-Gomez
- Unidad de Investigacion Biomolecular del Hospital de Cardiologia, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico DF, Mexico
| | | | - Sandra Orozco-Suarez
- Departamento de Fisiologia, Facultad de Medicina, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, Mexico
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17
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Role of Innate Immune Receptor TLR4 and its endogenous ligands in epileptogenesis. Pharmacol Res 2020; 160:105172. [PMID: 32871246 DOI: 10.1016/j.phrs.2020.105172] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
Understanding the interplay between the innate immune system, neuroinflammation, and epilepsy might offer a novel perspective in the quest of exploring new treatment strategies. Due to the complex pathology underlying epileptogenesis, no disease-modifying treatment is currently available that might prevent epilepsy after a plausible epileptogenic insult despite the advances in pre-clinical and clinical research. Neuroinflammation underlies the etiopathogenesis of epilepsy and convulsive disorders with Toll-like receptor (TLR) signal transduction being highly involved. Among TLR family members, TLR4 is an innate immune system receptor and lipopolysaccharide (LPS) sensor that has been reported to contribute to epileptogenesis by regulating neuronal excitability. Herein, we discuss available evidence on the role of TLR4 and its endogenous ligands, the high mobility group box 1 (HMGB1) protein, the heat shock proteins (HSPs) and the myeloid related protein 8 (MRP8), in epileptogenesis and post-traumatic epilepsy (PTE). Moreover, we provide an account of the promising findings of TLR4 modulation/inhibition in experimental animal models with therapeutic impact on seizures.
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18
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Sanz P, Garcia-Gimeno MA. Reactive Glia Inflammatory Signaling Pathways and Epilepsy. Int J Mol Sci 2020; 21:ijms21114096. [PMID: 32521797 PMCID: PMC7312833 DOI: 10.3390/ijms21114096] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 02/06/2023] Open
Abstract
Neuroinflammation and epilepsy are interconnected. Brain inflammation promotes neuronal hyper-excitability and seizures, and dysregulation in the glia immune-inflammatory function is a common factor that predisposes or contributes to the generation of seizures. At the same time, acute seizures upregulate the production of pro-inflammatory cytokines in microglia and astrocytes, triggering a downstream cascade of inflammatory mediators. Therefore, epileptic seizures and inflammatory mediators form a vicious positive feedback loop, reinforcing each other. In this work, we have reviewed the main glial signaling pathways involved in neuroinflammation, how they are affected in epileptic conditions, and the therapeutic opportunities they offer to prevent these disorders.
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Affiliation(s)
- Pascual Sanz
- Instituto de Biomedicina de Valencia (CSIC) and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Jaime Roig 11, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-963391779; Fax: +34-963690800
| | - Maria Adelaida Garcia-Gimeno
- Department of Biotechnology, Escuela Técnica Superior de Ingeniería Agronómica y del Medio Natural (ETSIAMN), Universitat Politècnica de València, 46022 Valencia, Spain;
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19
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Shen HY, Weltha L, Cook JM, Gesese R, Omi W, Baer SB, Rose RM, Reemmer J, Boison D. Sarcosine Suppresses Epileptogenesis in Rats With Effects on Hippocampal DNA Methylation. Front Mol Neurosci 2020; 13:97. [PMID: 32581708 PMCID: PMC7291815 DOI: 10.3389/fnmol.2020.00097] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/06/2020] [Indexed: 12/14/2022] Open
Abstract
Epileptogenesis is a common consequence of brain insults, however, the prevention or delay of the epileptogenic process remains an important unmet medical challenge. Overexpression of glycine transporter 1 (GlyT1) is proposed as a pathological hallmark in the hippocampus of patients with temporal lobe epilepsy (TLE), and we previously demonstrated in rodent epilepsy models that augmentation of glycine suppressed chronic seizures and altered acute seizure thresholds. In the present study we evaluated the effect of the GlyT1 inhibitor, sarcosine (aka N-methylglycine), on epileptogenesis and also investigated possible mechanisms. We developed a modified rapid kindling model of epileptogenesis in rats combined with seizure score monitoring to evaluate the antiepileptogenic effect of sarcosine. We used immunohistochemistry and Western blot analysis for the evaluation of GlyT1 expression and epigenetic changes of 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) in the epileptogenic hippocampi of rats, and further evaluated expression changes in enzymes involved in the regulation of DNA methylation, ten-eleven translocation methylcytosine dioxygenase 1 (TET1), DNA-methyltransferase 1 (DNMT1), and DNMT3a. Our results demonstrated: (i) experimental evidence that sarcosine (3 g/kg, i.p. daily) suppressed kindling epileptogenesis in rats; (ii) the sarcosine-induced antiepileptogenic effect was accompanied by a suppressed hippocampal GlyT1 expression as well as a reduction of hippocampal 5mC levels and a corresponding increase in 5hmC; and (iii) sarcosine treatment caused differential expression changes of TET1 and DNMTs. Together, these findings suggest that sarcosine has unprecedented disease-modifying properties in a kindling model of epileptogenesis in rats, which was associated with altered hippocampal DNA methylation. Thus, manipulation of the glycine system is a potential therapeutic approach to attenuate the development of epilepsy.
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Affiliation(s)
- Hai-Ying Shen
- RS Dow Neurobiology Laboratories, Department of Translational Neuroscience, Legacy Research Institute, Portland, OR, United States
| | - Landen Weltha
- RS Dow Neurobiology Laboratories, Department of Translational Neuroscience, Legacy Research Institute, Portland, OR, United States
| | - John M Cook
- RS Dow Neurobiology Laboratories, Department of Translational Neuroscience, Legacy Research Institute, Portland, OR, United States
| | - Raey Gesese
- RS Dow Neurobiology Laboratories, Department of Translational Neuroscience, Legacy Research Institute, Portland, OR, United States
| | - Wakaba Omi
- RS Dow Neurobiology Laboratories, Department of Translational Neuroscience, Legacy Research Institute, Portland, OR, United States
| | - Sadie B Baer
- RS Dow Neurobiology Laboratories, Department of Translational Neuroscience, Legacy Research Institute, Portland, OR, United States
| | - Rizelle Mae Rose
- RS Dow Neurobiology Laboratories, Department of Translational Neuroscience, Legacy Research Institute, Portland, OR, United States
| | - Jesica Reemmer
- RS Dow Neurobiology Laboratories, Department of Translational Neuroscience, Legacy Research Institute, Portland, OR, United States
| | - Detlev Boison
- RS Dow Neurobiology Laboratories, Department of Translational Neuroscience, Legacy Research Institute, Portland, OR, United States
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20
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Bouquier N, Girard B, Aparicio Arias J, Fagni L, Bertaso F, Perroy J. Gelatinase Biosensor Reports Cellular Remodeling During Epileptogenesis. Front Synaptic Neurosci 2020; 12:15. [PMID: 32372941 PMCID: PMC7186352 DOI: 10.3389/fnsyn.2020.00015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/19/2020] [Indexed: 12/26/2022] Open
Abstract
Epileptogenesis is the gradual process responsible for converting a healthy brain into an epileptic brain. This process can be triggered by a wide range of factors, including brain injury or tumors, infections, and status epilepticus. Epileptogenesis results in aberrant synaptic plasticity, neuroinflammation and seizure-induced cell death. As Matrix Metalloproteinases (MMPs) play a crucial role in cellular plasticity by remodeling the extracellular matrix (ECM), gelatinases (MMP-2 and MMP-9) were recently highlighted as key players in epileptogenesis. In this work, we engineered a biosensor to report in situ gelatinase activity in a model of epileptogenesis. This biosensor encompasses a gelatinase-sensitive activatable cell penetrating peptide (ACPP) coupled to a TAMRA fluorophore, allowing fluorescence uptake in cells displaying endogenous gelatinase activities. In a preclinical mouse model of temporal lobe epilepsy (TLE), the intrahippocampal kainate injection, ACPPs revealed a localized distribution of gelatinase activities, refining temporal cellular changes during epileptogenesis. The activity was found particularly but not only in the ipsilateral hippocampus, starting from the CA1 area and spreading to dentate gyrus from the early stages throughout chronic epilepsy, notably in neurons and microglial cells. Thus, our work shows that ACPPs are suitable molecular imaging probes for detecting the spatiotemporal pattern of gelatinase activity during epileptogenesis, suggesting their possible use as vectors to target cellular reactive changes with treatment for epileptogenesis.
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Affiliation(s)
| | - Benoit Girard
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | | | - Laurent Fagni
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Federica Bertaso
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Julie Perroy
- IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
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21
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Terrone G, Frigerio F, Balosso S, Ravizza T, Vezzani A. Inflammation and reactive oxygen species in status epilepticus: Biomarkers and implications for therapy. Epilepsy Behav 2019; 101:106275. [PMID: 31171434 DOI: 10.1016/j.yebeh.2019.04.028] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/15/2019] [Indexed: 01/13/2023]
Abstract
Preclinical studies in immature and adult rodents and clinical observations show that neuroinflammation and oxidative stress are rapid onset phenomena occurring in the brain during status epilepticus and persisting thereafter. Notably, both neuroinflammation and oxidative stress contribute to the acute and long-term sequelae of status epilepticus thus representing potential druggable targets. Antiinflammatory drugs that interfere with the IL-1β pathway, such as anakinra, can control benzodiazepine-refractory status epilepticus in animals, and there is recent proof-of-concept evidence for therapeutic effects in children with Febrile infection related epilepsy syndrome (FIRES). Inhibitors of monoacylglycerol lipase and P2X7 receptor antagonists are also promising antiinflammatory drug candidates for rapidly aborting de novo status epilepticus and provide neuroprotection. Antiinflammatory and antioxidant drugs administered to rodents during status epilepticus and transiently thereafter, prevent long-term sequelae such as cognitive deficits and seizure progression in animals developing epilepsy. Some drugs are already in medical use and are well-tolerated, therefore, they may be considered for treating status epilepticus and its neurological consequences. Finally, markers of neuroinflammation and oxidative stress are measureable in peripheral blood and by neuroimaging, which offers an opportunity for developing prognostic and predictive mechanistic biomarkers in people exposed to status epilepticus. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures.
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Affiliation(s)
- Gaetano Terrone
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Naples, Italy
| | - Federica Frigerio
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Silvia Balosso
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Ravizza
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Annamaria Vezzani
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
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22
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De Caro C, Iannone LF, Citraro R, Striano P, De Sarro G, Constanti A, Cryan JF, Russo E. Can we 'seize' the gut microbiota to treat epilepsy? Neurosci Biobehav Rev 2019; 107:750-764. [PMID: 31626816 DOI: 10.1016/j.neubiorev.2019.10.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 10/03/2019] [Accepted: 10/04/2019] [Indexed: 02/08/2023]
Abstract
The gut-microbiota, the complex intestinal microbial ecosystem essential to health, is an emerging concept in medicine. Several studies demonstrate a microbiota-gut-brain bidirectional connection via neural, endocrine, metabolic and immune pathways. Accordingly, the gut microbiota has a crucial role in modulating intestinal permeability, to alter local/peripheral immune responses and in production of essential metabolites and neurotransmitters. Its alterations may consequently influence all these pathways that contribute to neuronal hyper-excitability and mirrored neuroinflammation in epilepsy and similarly other neurological conditions. Indeed, pre- and clinical studies support the role of the microbiome in pathogenesis, seizure modulation and responses to treatment in epilepsy. Up to now, researchers have focussed attention above all on the brain to develop antiepileptic treatments, but considering the microbiome, could extend our possibilities for developing novel therapies in the future. We provide here a comprehensive overview of the available data on the potential role of gut microbiota in the physiopathology and therapy of epilepsy and the supposed underlying mechanisms.
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Affiliation(s)
- Carmen De Caro
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Luigi Francesco Iannone
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Rita Citraro
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, DINOGMI-Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, IRCCS "G. Gaslini" Institute, Genova, Italy
| | - Giovambattista De Sarro
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Andrew Constanti
- Department of Pharmacology, UCL School of Pharmacy, 29/39 Brunswick Square, London, United Kingdom
| | - John F Cryan
- UK.APC Microbiome Ireland, University College Cork, Cork, Ireland; Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
| | - Emilio Russo
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy.
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23
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Leo A, Citraro R, Tallarico M, Iannone M, Fedosova E, Nesci V, De Sarro G, Sarkisova K, Russo E. Cognitive impairment in the WAG/Rij rat absence model is secondary to absence seizures and depressive-like behavior. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109652. [PMID: 31095993 DOI: 10.1016/j.pnpbp.2019.109652] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/30/2019] [Accepted: 05/12/2019] [Indexed: 01/06/2023]
Abstract
Neuropsychiatric comorbidities are common in patients with epilepsy, remaining still an urgent unmet clinical need. Therefore, the management of epileptic disorders should not only be restricted to the achievement of seizure-freedom but must also be able to counteract its related comorbidities. Experimental animal models of epilepsy represent a valid tool not only to study epilepsy but also its associated comorbidities. The WAG/Rij rat is a well-established genetically-based model of absence epilepsy with depressive-like comorbidity, in which learning and memory impairment was also recently reported. Aim of this study was to clarify whether this cognitive decline is secondary or not to absence seizures and/or depressive-like behavior. The behavioral performance of untreated and ethosuximide-treated (300 mg/kg/day; 17 days) WAG/Rij rats at 6 and 12 months of age were assessed in several tests: forced swimming test, objects recognition test, social recognition test, Morris water maze and passive avoidance. According to our results, it seems that cognitive impairment in this strain, similarly to depressive-like behavior, is secondary to the occurrence of absence seizures, which might be necessary for the expression of cognitive impairment. Furthermore, our results suggest an age-dependent impairment of cognitive performance in WAG/Rij rats, which could be linked to the age-dependent increase of spike wave discharges. Consistently, it is possible that absence seizures, depressive-like behavior and cognitive deficit may arise independently and separately in lifetime from the same underlying network disease, as previously suggested for the behavioral features associated with other epileptic syndromes.
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Affiliation(s)
- Antonio Leo
- University of Catanzaro, School of Medicine, Science of Health Dept., Catanzaro, Italy
| | - Rita Citraro
- University of Catanzaro, School of Medicine, Science of Health Dept., Catanzaro, Italy.
| | - Martina Tallarico
- University of Catanzaro, School of Medicine, Science of Health Dept., Catanzaro, Italy; CNR, Institute of Neurological Sciences, Pharmacology Section, Roccelletta di Borgia, Catanzaro, Italy
| | - Michelangelo Iannone
- CNR, Institute of Neurological Sciences, Pharmacology Section, Roccelletta di Borgia, Catanzaro, Italy
| | - Ekaterina Fedosova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Moscow, Russia
| | - Valentina Nesci
- University of Catanzaro, School of Medicine, Science of Health Dept., Catanzaro, Italy
| | | | - Karine Sarkisova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Moscow, Russia
| | - Emilio Russo
- University of Catanzaro, School of Medicine, Science of Health Dept., Catanzaro, Italy
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Terrone G, Balosso S, Pauletti A, Ravizza T, Vezzani A. Inflammation and reactive oxygen species as disease modifiers in epilepsy. Neuropharmacology 2019; 167:107742. [PMID: 31421074 DOI: 10.1016/j.neuropharm.2019.107742] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/10/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023]
Abstract
Neuroinflammation and reactive oxygen and nitrogen species are rapidly induced in the brain after acute cerebral injuries that are associated with an enhanced risk for epilepsy in humans and related animal models. These phenomena reinforce each others and persist during epileptogenesis as well as during chronic spontaneous seizures. Anti-inflammatory and anti-oxidant drugs transiently administered either before, or shortly after the clinical onset of symptomatic epilepsy, similarly block the progression of spontaneous seizures, and may delay their onset. Moreover, neuroprotection and rescue of cognitive deficits are also observed in the treated animals. Therefore, although these treatments do not prevent epilepsy development, they offer clinically relevant disease-modification effects. These therapeutic effects are mediated by targeting molecular signaling pathways such as the IL-1β-IL-1 receptor type 1 and TLR4, P2X7 receptors, the transcriptional anti-oxidant factor Nrf2, while the therapeutic impact of COX-2 inhibition for reducing spontaneous seizures remains controversial. Some anti-inflammatory and anti-oxidant drugs that are endowed of disease modification effects in preclinical models are already in medical use and have a safety profile, therefore, they provide potential re-purposed treatments for improving the disease course and for reducing seizure burden. Markers of neuroinflammation and oxidative stress can be measured in blood or by neuroimaging, therefore they represent testable prognostic and predictive biomarkers for selecting the patient's population at high risk for developing epilepsy therefore eligible for novel treatments. This article is part of the special issue entitled 'New Epilepsy Therapies for the 21st Century - From Antiseizure Drugs to Prevention, Modification and Cure of Epilepsy'.
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Affiliation(s)
- Gaetano Terrone
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Silvia Balosso
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Alberto Pauletti
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Ravizza
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Annamaria Vezzani
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy.
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Santos-Valencia F, Almazán-Alvarado S, Rubio-Luviano A, Valdés-Cruz A, Magdaleno-Madrigal VM, Martínez-Vargas D. Temporally irregular electrical stimulation to the epileptogenic focus delays epileptogenesis in rats. Brain Stimul 2019; 12:1429-1438. [PMID: 31378602 DOI: 10.1016/j.brs.2019.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/08/2019] [Accepted: 07/23/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Variation in the temporal patterns of electrical pulses in stimulation trains has opened a new field of opportunity for the treatment of neurological disorders, such as pharmacoresistant temporal lobe epilepsy. Whether this novel type of stimulation affects epileptogenesis remains to be investigated. OBJECTIVE The purpose of this study was to analyze the effects of temporally irregular deep brain stimulation on kindling-induced epileptogenesis in rats. METHODS Temporally irregular deep brain stimulation was delivered at different times with respect to the kindling stimulation. Behavioral and electrographic changes on kindling acquisition were compared with a control group and a temporally regular deep brain stimulation-treated group. The propagation of epileptiform activity was analyzed with wavelet cross-correlation analysis, and interictal epileptiform discharge ratios were obtained. RESULTS Temporally irregular deep brain stimulation delivered in the epileptogenic focus during the interictal period shortened the daily afterdischarge duration, slowed the progression of seizure stages, diminished the generalized seizure duration and interfered with the propagation of epileptiform activity from the seizure onset zone to the ipsi- and contralateral motor cortex. We also found a negative correlation between seizure severity and interictal epileptiform discharges in rats stimulated with temporally irregular deep brain stimulation. CONCLUSION These results provide evidence that temporally irregular deep brain stimulation interferes with the establishment of epilepsy by delaying epileptogenesis by almost twice as long in kindling animals. Thus, temporally irregular deep brain stimulation could be a preventive approach against epilepsy.
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Affiliation(s)
- Fernando Santos-Valencia
- Laboratorio de Neurofisiología del Control y la Regulación, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calz. México-Xochimilco 101, Col. San Lorenzo Huipulco, 14370, Ciudad de México, Mexico
| | - Salvador Almazán-Alvarado
- Laboratorio de Bioelectrónica, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calz. México-Xochimilco 101, Col. San Lorenzo Huipulco, 14370, Ciudad de México, Mexico
| | - Alejandro Rubio-Luviano
- Laboratorio de Neurofisiología del Control y la Regulación, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calz. México-Xochimilco 101, Col. San Lorenzo Huipulco, 14370, Ciudad de México, Mexico
| | - Alejandro Valdés-Cruz
- Laboratorio de Neurofisiología del Control y la Regulación, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calz. México-Xochimilco 101, Col. San Lorenzo Huipulco, 14370, Ciudad de México, Mexico
| | - Victor Manuel Magdaleno-Madrigal
- Laboratorio de Neurofisiología del Control y la Regulación, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calz. México-Xochimilco 101, Col. San Lorenzo Huipulco, 14370, Ciudad de México, Mexico
| | - David Martínez-Vargas
- Laboratorio de Neurofisiología del Control y la Regulación, Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría "Ramón de la Fuente Muñiz", Calz. México-Xochimilco 101, Col. San Lorenzo Huipulco, 14370, Ciudad de México, Mexico.
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Girard B, Tuduri P, Moreno MP, Sakkaki S, Barboux C, Bouschet T, Varrault A, Vitre J, McCort-Tranchepain I, Dairou J, Acher F, Fagni L, Marchi N, Perroy J, Bertaso F. The mGlu7 receptor provides protective effects against epileptogenesis and epileptic seizures. Neurobiol Dis 2019; 129:13-28. [PMID: 31051234 DOI: 10.1016/j.nbd.2019.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/28/2019] [Accepted: 04/29/2019] [Indexed: 01/26/2023] Open
Abstract
Finding new targets to control or reduce seizure activity is essential to improve the management of epileptic patients. We hypothesized that activation of the pre-synaptic and inhibitory metabotropic glutamate receptor type 7 (mGlu7) reduces spontaneous seizures. We tested LSP2-9166, a recently developed mGlu7/4 agonist with unprecedented potency on mGlu7 receptors, in two paradigms of epileptogenesis. In a model of chemically induced epileptogenesis (pentylenetetrazole systemic injection), LSP2-9166 induces an anti-epileptogenic effect rarely observed in preclinical studies. In particular, we found a bidirectional modulation of seizure progression by mGlu4 and mGlu7 receptors, the latter preventing kindling. In the intra-hippocampal injection of kainic acid mouse model that mimics the human mesial temporal lobe epilepsy, we found that LSP2-9166 reduces seizure frequency and hippocampal sclerosis. LSP2-9166 also acts as an anti-seizure drug on established seizures in both models tested. Specific modulation of the mGlu7 receptor could represent a novel approach to reduce pathological network remodeling.
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Affiliation(s)
- Benoit Girard
- IGF, CNRS, INSERM, Univ Montpellier, Montpellier, France
| | - Pola Tuduri
- IGF, CNRS, INSERM, Univ Montpellier, Montpellier, France
| | | | - Sophie Sakkaki
- IGF, CNRS, INSERM, Univ Montpellier, Montpellier, France
| | | | | | - Annie Varrault
- IGF, CNRS, INSERM, Univ Montpellier, Montpellier, France
| | - Jihane Vitre
- IGF, CNRS, INSERM, Univ Montpellier, Montpellier, France
| | | | | | | | - Laurent Fagni
- IGF, CNRS, INSERM, Univ Montpellier, Montpellier, France
| | - Nicola Marchi
- IGF, CNRS, INSERM, Univ Montpellier, Montpellier, France
| | - Julie Perroy
- IGF, CNRS, INSERM, Univ Montpellier, Montpellier, France
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Song MX, Deng XQ. Recent developments on triazole nucleus in anticonvulsant compounds: a review. J Enzyme Inhib Med Chem 2018; 33:453-478. [PMID: 29383949 PMCID: PMC6010125 DOI: 10.1080/14756366.2017.1423068] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 12/27/2017] [Accepted: 12/27/2017] [Indexed: 11/02/2022] Open
Abstract
Epilepsy is one of the common diseases seriously threatening life and health of human. More than 50 million people are suffering from this condition and anticonvulsant agents are the main treatment. However, side effects and intolerance, and a lack of efficacy limit the application of the current anticonvulsant agents. The search for new anticonvulsant agents with higher efficacy and lower toxicity continues to be the focus and task in medicinal chemistry. Numbers of triazole derivatives as clinical drugs or candidates have been frequently employed for the treatment of various types of diseases, which have proved the importance of this heterocyclic nucleus in drug design and discovery. Recently many endeavours were made to involve the triazole into the anticonvulsants design, which have brought lots of active compounds. This work is an attempt to systematically review the research of triazole derivatives in the design and development of anticonvulsant agents during the past two decades.
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Affiliation(s)
- Ming-Xia Song
- Medical College, Jinggangshan University, Ji’an, Jiangxi, China
| | - Xian-Qing Deng
- Medical College, Jinggangshan University, Ji’an, Jiangxi, China
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Parrish RR, Codadu NK, Racca C, Trevelyan AJ. Pyramidal cell activity levels affect the polarity of activity-induced gene transcription changes in interneurons. J Neurophysiol 2018; 120:2358-2367. [PMID: 30110232 PMCID: PMC6295532 DOI: 10.1152/jn.00287.2018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Changes in gene expression are an important mechanism by which activity levels are regulated in the nervous system. It is not known, however, how network activity influences gene expression in interneurons; since they themselves provide negative feedback in the form of synaptic inhibition, there exists a potential conflict between their cellular homeostatic tendencies and those of the network. We present a means of examining this issue, utilizing simple in vitro models showing different patterns of intense network activity. We found that the degree of concurrent pyramidal activation changed the polarity of the induced gene transcription. When pyramidal cells were quiescent, interneuronal activation led to an upregulation of glutamate decarboxylase 1 ( GAD1) and parvalbumin ( Pvalb) gene transcriptions, mediated by activation of the Ras/extracellular signal-related kinase mitogen-activated protein kinase (Ras/ERK MAPK) pathway. In contrast, coactivation of pyramidal cells led to an ionotropic glutamate receptor N-methyl-d-aspartate 2B-dependent decrease in transcription. Our results demonstrate a hitherto unrecognized complexity in how activity-dependent gene expression changes are manifest in cortical networks. NEW & NOTEWORTHY We demonstrate a novel feedback mechanism in cortical networks, by which glutamatergic drive, mediated through the Ras/ERK MAPK pathway, regulates gene transcription in interneurons. Using a unique feature of certain in vitro epilepsy models, we show that without this glutamatergic feedback, intense activation of interneurons causes parvalbumin and glutamate decarboxylase 1 mRNA expression to increase. If, on the other hand, pyramidal cells are coactivated with interneurons, this leads to a downregulation of these genes.
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Affiliation(s)
- R Ryley Parrish
- Institute of Neuroscience, Medical School , Newcastle University, Newcastle upon Tyne , United Kingdom
| | - Neela K Codadu
- Institute of Neuroscience, Medical School , Newcastle University, Newcastle upon Tyne , United Kingdom
| | - Claudia Racca
- Institute of Neuroscience, Medical School , Newcastle University, Newcastle upon Tyne , United Kingdom
| | - Andrew J Trevelyan
- Institute of Neuroscience, Medical School , Newcastle University, Newcastle upon Tyne , United Kingdom.,Columbia Translational Neuroscience Initiative, Department of Neurology, Columbia University , New York, New York
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Genetic Modulation of HSPA1A Accelerates Kindling Progression and Exerts Pro-convulsant Effects. Neuroscience 2018; 386:108-120. [PMID: 29964156 DOI: 10.1016/j.neuroscience.2018.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 06/05/2018] [Accepted: 06/19/2018] [Indexed: 12/20/2022]
Abstract
Strong evidence exists that Toll-like receptor (TLR)-mediated effects on microglia functional states can promote ictogenesis and epileptogenesis. So far, research has focused on the role of high-mobility group box protein 1 as an activator of TLRs. However, the development of targeting strategies might need to consider a role of additional receptor ligands. Considering the fact that heat shock protein A1 (hsp70) has been confirmed as a TLR 2 and 4 ligand, we have explored the consequences of its overexpression in a mouse kindling paradigm. The genetic modulation enhanced seizure susceptibility with lowered seizure thresholds prior to kindling. In contrast to wildtype (WT) mice, HSPA1A transgenic (TG) mice exhibited generalized seizures very early during the kindling paradigm. Along with an increased seizure severity, seizure duration proved to be prolonged in TG mice during this phase. Toward the end of the stimulation phase seizure parameters of WT mice reached comparable levels. However, a difference between genotypes was still evident when comparing seizure parameters during the post-kindling threshold determination. Surprisingly, HSPA1A overexpression did not affect microglia activation in the hippocampus. In conclusion, the findings demonstrate that hsp70 can exert pro-convulsant effects promoting ictogenesis in naïve animals. The pronounced impact on the response to subsequent stimulations gives first evidence that genetic HSPA1A upregulation may also contribute to epileptogenesis. Thus, strategies inhibiting hsp70 or its expression might be of interest for prevention of seizures and epilepsy. However, conclusions about a putative pro-epileptogenic effect of hsp70 require further investigations in models with development of spontaneous recurrent seizures.
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Abstract
PURPOSE OF REVIEW Cognitive impairments are common in children with epilepsy. They may already be present before the onset of epilepsy or occur - and even progress - during its course. Many variables contribute to cognitive dysfunction. Those that can be targeted to prevent (further) cognitive impairment will be highlighted in this review. RECENT FINDINGS Ideally, but not yet realistically, epileptogenesis is prevented to avert seizures and cognitive impairments in high-risk patients. New and targeted treatments of progressive epileptogenic disorders and precision medicine approaches in genetic epilepsies are increasingly applied. Cognitive outcome benefits from early diagnosis and treatment of epileptic encephalopathy. Ongoing seizures may cause permanent and progressive changes in brain structure and connectivity, suggesting that early seizure control optimizes eventual cognitive functioning. Frequent interictal epileptiform discharges justify treatment in children with cognitive impairments that are otherwise unexplained. Cognitive adverse effects of antiepileptic drugs should be closely monitored and balanced against potential benefits. Finally, early surgical treatment in selected candidates will improve their cognitive outcome. SUMMARY Although important determinants of intellectual functioning - including the child's genetic and environmental background and the epileptogenic pathology - may not be modifiable, several variables that contribute to cognitive impairment can be targeted to improve outcome. Early etiological diagnosis, personalized therapies, presurgical evaluation, and strict control of seizures - or in some patients interictal discharges - can prevent (further) cognitive impairments.
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Kim JA, Boyle E, Wu AC, Cole AJ, Staley KJ, Zafar S, Cash SS, Westover MB. Epileptiform activity in traumatic brain injury predicts post-traumatic epilepsy. Ann Neurol 2018; 83:858-862. [PMID: 29537656 PMCID: PMC5912971 DOI: 10.1002/ana.25211] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/02/2018] [Accepted: 03/09/2018] [Indexed: 02/02/2023]
Abstract
We hypothesize that epileptiform abnormalities (EAs) in the electroencephalogram (EEG) during the acute period following traumatic brain injury (TBI) independently predict first-year post-traumatic epilepsy (PTE1 ). We analyze PTE1 risk factors in two cohorts matched for TBI severity and age (n = 50). EAs independently predict risk for PTE1 (odds ratio [OR], 3.16 [0.99, 11.68]); subdural hematoma is another independent risk factor (OR, 4.13 [1.18, 39.33]). Differences in EA rates are apparent within 5 days following TBI. Our results suggest that increased EA prevalence identifies patients at increased risk for PTE1 , and that EAs acutely post-TBI can identify patients most likely to benefit from antiepileptogenesis drug trials. Ann Neurol 2018;83:858-862.
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Affiliation(s)
- Jennifer A. Kim
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Neurology and Neurocritical Care, Massachusetts General Hospital, Boston, MA, USA
| | | | - Alexander C. Wu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Andrew J. Cole
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kevin J Staley
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Sahar Zafar
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Neurology and Neurocritical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Sydney S. Cash
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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van Vliet EA, Aronica E, Vezzani A, Ravizza T. Review: Neuroinflammatory pathways as treatment targets and biomarker candidates in epilepsy: emerging evidence from preclinical and clinical studies. Neuropathol Appl Neurobiol 2018; 44:91-111. [DOI: 10.1111/nan.12444] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/28/2017] [Indexed: 12/12/2022]
Affiliation(s)
- E. A. van Vliet
- Department of (Neuro)pathology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
| | - E. Aronica
- Department of (Neuro)pathology; Academic Medical Center; University of Amsterdam; Amsterdam The Netherlands
- Swammerdam Institute for Life Sciences; Center for Neuroscience; University of Amsterdam; Amsterdam The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN); Cruquius The Netherlands
| | - A. Vezzani
- Department of Neuroscience; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milano Italy
| | - T. Ravizza
- Department of Neuroscience; IRCCS-Istituto di Ricerche Farmacologiche Mario Negri; Milano Italy
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Schulze-Bonhage A. A 2017 review of pharmacotherapy for treating focal epilepsy: where are we now and how will treatment develop? Expert Opin Pharmacother 2017; 18:1845-1853. [DOI: 10.1080/14656566.2017.1391788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Leo A, Citraro R, Amodio N, De Sarro C, Gallo Cantafio ME, Constanti A, De Sarro G, Russo E. Fingolimod Exerts only Temporary Antiepileptogenic Effects but Longer-Lasting Positive Effects on Behavior in the WAG/Rij Rat Absence Epilepsy Model. Neurotherapeutics 2017; 14:1134-1147. [PMID: 28653281 PMCID: PMC5722759 DOI: 10.1007/s13311-017-0550-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
One of the major challenges in the epilepsy field is identifying disease-modifying drugs in order to prevent or delay spontaneous recurrent seizure onset or to cure already established epilepsy. It has been recently reported that fingolimod, currently approved for the treatment of relapsing-remitting multiple sclerosis, has demonstrated antiepileptogenic effects in 2 different preclinical models of acquired epilepsy. However, to date, no data exist regarding the role of fingolimod against genetic epilepsy. Therefore, we have addressed this issue by studying the effects of fingolimod in Wistar Albino Glaxo/Rijswijk (WAG/Rij) rats, a well-established genetic model of absence epilepsy, epileptogenesis, and neuropsychiatric comorbidity. Our results have demonstrated that an early long-term treatment with fingolimod (1 mg/kg/day), started before absence seizure onset, has both antiepileptogenic and antidepressant-like effects in WAG/Rij rats. However, these effects were transitory, as 5 months after treatment discontinuation, both absence seizure and depressive like-behavior returned to control levels. Furthermore, a temporary reduction of mTOR signaling pathway activity, indicated by reduced phosphorylated mammalian target of rapamycin and phosphorylated p70S6k levels, and by increased phosphorylated Akt in WAG/Rij rats of 6 months of age accompanied the transitory antiepileptogenic effects of fingolimod. Surprisingly, fingolimod has demonstrated longer-lasting positive effects on cognitive decline in this strain. This effect was accompanied by an increased acetylation of lysine 8 of histone H4 (at both 6 and 10 months of age). In conclusion, our results support the antiepileptogenic effects of fingolimod. However, the antiepileptogenic effects were transitory. Moreover, fingolimod might also have a positive impact on animal behavior and particularly in protecting the development of memory decline.
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Affiliation(s)
- Antonio Leo
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Nicola Amodio
- Department of Experimental and Clinical Medicine, Magna Graecia University and Translational Medical Oncology Unit, Salvatore Venuta University Campus, Catanzaro, Italy
| | - Caterina De Sarro
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Maria Eugenia Gallo Cantafio
- Department of Experimental and Clinical Medicine, Magna Graecia University and Translational Medical Oncology Unit, Salvatore Venuta University Campus, Catanzaro, Italy
| | | | - Giovambattista De Sarro
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.
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Ferlazzo E, Sueri C, Gasparini S, Russo E, Cianci V, Ascoli M, De Sarro G, Aguglia U. Methodological issues associated with clinical trials in epilepsy. Expert Rev Clin Pharmacol 2017; 10:1103-1108. [PMID: 28715945 DOI: 10.1080/17512433.2017.1356720] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION despite methodological advances in epilepsy clinical trials, the proportion of patients reaching seizure-freedom has not substantially changed over the years. We review the main methodological limitations of current trials, the possible strategies to overcome these limits, and the issues that need to be addressed in next future. Area covered: references were identified by PubMed search until March 2017 and unpublished literature was searched on ClinicalTrials.gov. Add-on trials mainly involve refractory epilepsy subjects, reducing overall response to the investigational drug. The inclusion of subjects with earlier disease from less developed countries has partially allowed overcoming this limitation, but has introduced more random variability of results. Monotherapy trials rise methodological, economical, and ethical concerns with different regulatory requirements in European Union and in the United States of America. Newer trial designs, such as futility trials or 'time-to-event' design, have been implemented. Moreover, both add-on and monotherapy trials results might be affected by patient's ability to recognize and record seizures, and by randomness of seizures occurrence over time. Possible strategies to achieve more reliable outcomes are detailed. Expert commentary: clinical trial methodology needs to be optimized to better address regulatory agencies requirements and to encounter both patients' and clinicians' needs.
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Affiliation(s)
- Edoardo Ferlazzo
- a Regional Epilepsy Centre , Bianchi-Melacrino-Morelli Hospital , Reggio Calabria , Italy.,b Department of Medical and Surgical Sciences , Magna Graecia University , Catanzaro , Italy
| | - Chiara Sueri
- a Regional Epilepsy Centre , Bianchi-Melacrino-Morelli Hospital , Reggio Calabria , Italy
| | - Sara Gasparini
- a Regional Epilepsy Centre , Bianchi-Melacrino-Morelli Hospital , Reggio Calabria , Italy.,b Department of Medical and Surgical Sciences , Magna Graecia University , Catanzaro , Italy
| | - Emilio Russo
- c Department of Science of Health , Magna Graecia University , Catanzaro , Italy
| | - Vittoria Cianci
- a Regional Epilepsy Centre , Bianchi-Melacrino-Morelli Hospital , Reggio Calabria , Italy
| | - Michele Ascoli
- a Regional Epilepsy Centre , Bianchi-Melacrino-Morelli Hospital , Reggio Calabria , Italy.,b Department of Medical and Surgical Sciences , Magna Graecia University , Catanzaro , Italy
| | | | - Umberto Aguglia
- a Regional Epilepsy Centre , Bianchi-Melacrino-Morelli Hospital , Reggio Calabria , Italy.,b Department of Medical and Surgical Sciences , Magna Graecia University , Catanzaro , Italy
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In vitro and in silico evaluation of chromene based aroyl hydrazones as anticonvulsant agents. Med Chem Res 2017. [DOI: 10.1007/s00044-017-1902-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Chen YC, Zhu GY, Wang X, Shi L, Jiang Y, Zhang X, Zhang JG. Deep brain stimulation of the anterior nucleus of the thalamus reverses the gene expression of cytokines and their receptors as well as neuronal degeneration in epileptic rats. Brain Res 2016; 1657:304-311. [PMID: 28027874 DOI: 10.1016/j.brainres.2016.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/16/2016] [Accepted: 12/20/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deep brain stimulation of the anterior nucleus of the thalamus (ANT-DBS) is effective in seizure control. However, the mechanisms remain unclear. METHODS Sixty-four rats were randomly assigned to the control group, the kainic acid (KA) group, the sham-DBS group and the DBS group. Video-electroencephalogram (EEG) was used to monitor seizures. Quantitative real time PCR (qPCR) was applied for detecting interleukin-1 beta (IL-1β), IL-1 receptor (IL-1R), IL-6, IL-6 receptor (IL-6R), gp130, tumor necrosis factor-alpha (TNF-α), TNF-receptor 1 (TNF-R1) and TNF-receptor 2 (TNF-R2) expression 12h after the establishment of an epileptic model. The neuronal structural degeneration in the hippocampus was evaluated with transmission electron microscopy (TEM) at this same time point. RESULTS The seizure frequency was 48.6% lower in the DBS group compared with the sham-DBS group (P<0.01). The expression of IL-1β, IL-1R, IL-6, IL-6R, gp130, TNF-α and TNF-R1 was elevated in both the KA and the sham group compared with the control group (all Ps<0.01). Additionally, ANT-DBS was able to reverse this gene expression pattern in the DBS group compared with the sham-DBS group (all Ps<0.01). There was no significant difference in TNF-R2 expression among the four groups. The neuronal structural degeneration in the KA group and the sham-DBS group was more severe than that in the control group (injury scores, all Ps<0.01). ANT-DBS was also capable of relieving the degeneration compared with the sham-DBS group (injury score, P<0.01). CONCLUSIONS This study demonstrated that ANT-DBS can reduce seizure frequency in the early stage in epileptic rats as well as relieve the pro-inflammatory state and neuronal injury, which may be one of the most effective mechanisms of ANT-DBS against epileptogenesis.
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Affiliation(s)
- Ying-Chuan Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - Guan-Yu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China.
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China.
| | - Xin Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China.
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China; Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100050, China; Beijing Key Laboratory of Neurostimulation, Beijing 100050, China.
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De Sarro G. Managing epilepsy in the third millenium: Recent achievements and future perspectives. Pharmacol Res 2016; 113:332-334. [PMID: 27594420 DOI: 10.1016/j.phrs.2016.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 08/27/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Giovambattista De Sarro
- Department of Science of Health, Clinical Pharmacology and Pharmacovigilance Unit, School of Medicine and Surgery, University of Catanzaro, Italy.
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