The neuromatrix and the epileptic brain: behavioral and learning preservation in limbic epileptic rats treated with ketamine but not acepromazine

Cognitive comorbidities in the rat pilocarpine model of epilepsy

Patients with epilepsy are prone to cognitive decline, depression, anxiety and other behavioral disorders. Cognitive comorbidities are particularly common and well-characterized in people with temporal lobe epilepsy, while inconsistently addressed in epileptic animals. Therefore, the aim of this study was to ascertain whether there is good evidence of cognitive comorbidities in animal models of epilepsy, in particular in the rat pilocarpine model of temporal lobe epilepsy. We searched the literature published between 1990 and 2023. The association of spontaneous recurrent seizures induced by pilocarpine with cognitive alterations has been evaluated by using various tests: contextual fear conditioning (CFC), novel object recognition (NOR), radial and T-maze, Morris water maze (MWM) and their variants. Combination of results was difficult because of differences in methodological standards, in number of animals employed, and in outcome measures. Taken together, however, the analysis confirmed that pilocarpine-induced epilepsy has an effect on cognition in rats, and supports the notion that this is a valid model for assessment of cognitive temporal lobe epilepsy comorbidities in preclinical research.

Impairments in cognitive functions and emotional and social behaviors in a rat lithium-pilocarpine model of temporal lobe epilepsy

The aim of this study was to evaluate in detail behavioral patterns and comorbid disturbances in rats using the lithium-pilocarpine model. A comprehensive set of behavioral tests was used to investigate behavioral patterns, including the open field test, Morris water maze, Y-maze, fear conditioning, the elevated plus maze, the forced swimming test, and the resident-intruder paradigm. Motor and explorative activity, learning and memory, anxiety and depressive-like behavior, aggression, and communication were evaluated 8-15 d after pilocarpine-induced status epilepticus (SE) (latent phase of the model) and 41-53 d (chronic phase) after pilocarpine-induced SE. Increased motor activity and impaired memory function were the most noticeable behavioral modifications in the epileptic rats. Both the movement speed and distance traveled increased in the open field test in both the latent and chronic phases. Significant impairments were detected in short-and long-term spatial memory in the Morris water maze during the latent phase. Besides the alterations in spatial memory, behaviors indicative of short- and long-term fear-associated memory disturbances were observed in the fear conditioning test during the chronic phase of the model. In the resident-intruder paradigm, epileptic rats exhibited disturbed communicative behavior, with impaired social behaviors. In contrast, emotional disturbances were less prominent, with the rats exhibiting decreased anxiety. There were no changes in depressive-like behavior. The data suggest that the lithium-pilocarpine model of TLE in rodents is more useful for studies of comorbid disturbances in memory, hyperactivity, and social behavior than for research on psychoemotional impairments, such as anxiety and depression.

Treatment of status epilepticus with ketamine, are we there yet?

Status epilepticus (SE), a neurological emergency both in adults and in children, could lead to brain damage and even death if untreated. Generalized convulsive SE (GCSE) is the most common and severe form, an example of which is that induced by organophosphorus nerve agents. First- and second-line pharmacotherapies are relatively consensual, but if seizures are still not controlled, there is currently no definitive data to guide the optimal choice of therapy. The medical community seems largely reluctant to use ketamine, a noncompetitive antagonist of the N-methyl-d-aspartate glutamate receptor. However, a review of the literature clearly shows that ketamine possesses, in preclinical studies, antiepileptic properties and provides neuroprotection. Clinical evidences are scarcer and more difficult to analyze, owing to a use in situations of polytherapy. In absence of existing or planned randomized clinical trials, the medical community should make up its mind from well-conducted preclinical studies performed on appropriate models. Although potentially active, ketamine has no real place for the treatment of isolated seizures, better accepted drugs being used. Its best usage should be during GCSE, but not waiting for SE to become totally refractory. Concerns about possible developmental neurotoxicity might limit its pediatric use for refractory SE.

Post-seizure drug treatment in young rats determines clear incremental losses of frontal cortical and hippocampal neurons: the resultant damage is similar to very old brains

Loss of neurons occurs with aging and following lithium/pilocarpine-induced epileptic seizures. In the present study, the numbers of neurons within the layers from sample areas of the four lobes of the neocortices and the hippocampus were counted by light microscopy in brains of rats that had been administered lithium or pilocarpine and then injected immediately or shortly after seizure onset with either acepromazine, ketamine, or prazosin. The mean numbers of neocortical and hippocampal neurons were lowest in rats treated with acepromazine or prazosin 1h after seizure onset, while those of rats immediately treated with ketamine displayed the least decrements and were most similar to normal rats. The largest loss of neurons occurred within the CA1 field and layers 5 and 6 of the frontal cortices. The mean numbers of neurons within the cortices in rats whose treatments had been delayed for 1h were similar to those of normal rats over 700 days of age. These results support the hypothesis that neuronal loss from cumulative effects of seizure-induced brain damage simulates aging.

Large differences in blood measures, tissue weights, and focal areas of damage 1 year after postseizure treatment with acepromazine or ketamine

Approximately 1 year after rats were seized as young adults with lithium (3 mEq/kg) and pilocarpine (30 mg/kg) and given acepromazine or ketamine, 18 blood measures, wet tissue weights, and detailed damage scores for 107 brain structures were completed. Compared with normal and ketamine-treated rats, acepromazine-treated seized rats (total n=54) had lighter pancreata and spleens and elevated aspartate aminotransferase and alanine aminotransferase blood levels. Even though average damage did not differ, the mosaic of brain damage completely discriminated the two seized groups. Differential effects of postseizure treatment on functions of the thyroid, pancreas, and spleen were indicated. Ketamine-treated seized rats were healthier than acepromazine-treated seized rats or normal rats. This experiment demonstrates the importance of whole-organism assessment and that the single administration of a specific drug after onset of status epilepticus can produce marked differences in the evolution of brain damage and its influence on specific organs for the rest of the animal's life.

Behavioral changes with brief exposures to weak magnetic fields patterned to stimulate long-term potentiation

Brief whole body exposures of rats to weak (1 microT) complex magnetic fields whose patterns induce long term potential (LTP) when applied as electric current to hippocampal slices produced powerful behavioral changes. Rats exposed for 30 min before but not 30 min after hourly training sessions for spatial memory displayed impairments comparable to those elicited by complete electrode-induced saturation of hippocampal activity. Exposure to the same LTP-patterned magnetic fields after weaning during the induction of limbic seizures produced diminished learning of conditioned contextual fear during adulthood. However exposure to magnetic fields designed to simulate a "virtual" hippocampal state during acquisition of a timed inhibitory task (DRL) facilitated performance. These results show that physiologically-patterned magnetic fields can produce dramatic changes in behavior when they are applied during states associated with marked synaptic plasticity.

Increased conditioned immobility and weight loss in rats following mechanical impacts to the skull that do not produce loss of consciousness

Rats either received a single vertical impact (15 km/h) of mechanical energy to their right dorsal skulls over the parietal region or served as handled controls. About 50% of the rats appeared normal after the impact. Thirty days later there were conspicuous areas containing neurons with shrunken and darkly stained somas within the cortices beneath the impact site and within the amygdala and entorhinal cortices. These neurons, occupying an average total area that ranged from 0.50 mm2 to 5 mm2, were evident even in rats that showed no stunning following the impact. These neurons were not seen in control rats. Subsequent decreases in body weight for rats that received the impact (even with no obvious stunning) were attenuated by oral access to 10% glucose but not by treatment with acetaminophen or ketamine. The rats that sustained the impact also displayed increased immobility within settings with which an aversive stimulus had been associated. Post-impact injection with ketamine did not normalize this behaviour. These results show that quantitative changes in some neuronal soma remain weeks after a single impact of mechanical energy that is not associated with immediate changes in behaviour. Concomitant with these neuronal alterations was increased emotional responsiveness to contexts associated with a single aversive episode and transient decreases in body weights.

Glutamate-induced c-Jun expression in neuronal PC12 cells: the effects of ketamine and propofol

Transcription factor c-Jun affects neuronal cell death and survival in mammalian brain. As general anesthetics, such as ketamine and propofol, are thought to provide some degree of neuroprotection, this study was intended to test whether the protection of injured neuronal PC12 cells by ketamine and propofol is related to the inhibition of phospho-c-Jun. Using neuronal PC12 cells from rat pheochromocytoma cells differentiated with nerve growth factor, we found that 24 hours of exposure to glutamate (1 to 100 mM) induced concentration-dependent cell death as determined by an ability to reduce the tetrazolium derivative, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) into a blue formazan salt. Neuronal PC12 cells were exposed to ketamine (0.1, 1.0 mM) or propofol (0.5, 5.0 microM) and glutamate (0, 20 mM) for 24 hours. Cell injury was assessed using MTT, in situ terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling, and c-Jun activity assay. Glutamate, 20 mM, induced about 70% of cell death as determined by MTT and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling staining. Glutamate-induced cell death was related to an increase in expression of phospho-c-Jun. Glutamate-induced cell death was reduced by ketamine (0.1, 1.0 mM) in a dose-dependent manner and also by propofol (0.5, 5.0 microM). In addition, the expression of phospho-c-Jun was substantially reduced by ketamine (0.1, 1.0 mM) and propofol (0.5, 5.0 microM), respectively, as determined by Western blot assay. These results suggest that inhibition of c-Jun activity is involved in the neuroprotective effects of ketamine and propofol on glutamate-induced injury in neuronal PC12 cells.

Weak, physiologically patterned magnetic fields do not affect maze performance in normal rats, but disrupt seized rats normalized with ketamine: possible support for a neuromatrix concept?

The concept of a neuromatrix as a determinant of behavior proposes that complex neuroelectromagnetic patterns supported by specific spatial configurations of neurons underlie the generation of behaviors. When the pattern of neuronal connectivity is changed, as occurs during limbic epilepsy, neuroelectromagnetic patterns change in parallel to sustain behavioral output. Thus, a testable prediction of the neuromatrix concept is that the "normal" behaviors of animals with markedly reorganized neuroelectromagnetic patterns are vulnerable to specific stimuli that are ineffective when applied to a normal population. Because rats treated with ketamine after being induced to seize with pilocarpine exhibit behaviors indistinguishable from those of control populations despite marked changes in brain structure, they represent an ideal population in which to examine this hypothesis. Ketamine-treated pilocarpine-seized rats and normal rats were exposed continuously either to a complex sequence magnetic field or to control conditions during the acquisition of a radial arm maze task for 8 consecutive days. After 14 days of subsequent exposure to a frequency-modulated field (7-500 nT), during which time there was no training, the rats that had been induced to seize and had been exposed continuously to this magnetic configuration exhibited conspicuously slower response durations per arm than rats that had been induced to seize and exposed to control conditions or normal rats that had been exposed to either magnetic fields or control conditions. Thus, the behaviors of rats who have sustained multiple, discrete injuries throughout the brain may be seriously disrupted by the appropriate pattern of exogenous weak magnetic fields. Our results represent the first empirical support for the concept of the neuromatrix.

Revising a Dogma: Ketamine for Patients with Neurological Injury?

We evaluated reports of randomized clinical trials in the perioperative and intensive care setting concerning ketamine's effects on the brain in patients with, or at risk for, neurological injury. We also reviewed other studies in humans on the drug's effects on the brain, and reports that examined ketamine in experimental brain injury. In the clinical setting, level II evidence indicates that ketamine does not increase intracranial pressure when used under conditions of controlled ventilation, coadministration of a gamma-aminobutyric acid (GABA) receptor agonist, and without nitrous oxide. Ketamine may thus safely be used in neurologically impaired patients. Compared with other anesthetics or sedatives, level II and III evidence indicates that hemodynamic stimulation induced by ketamine may improve cerebral perfusion; this could make the drug a preferred choice in sedative regimes after brain injury. In the laboratory, ketamine has neuroprotective, and S(+)-ketamine additional neuroregenerative effects, even when administered after onset of a cerebral insult. However, improved outcomes were only reported in studies with brief recovery observation intervals. In developing animals, and in certain brain areas of adult rats without cerebral injury, neurotoxic effects were noted after large-dose ketamine. These were prevented by coadministration of GABA receptor agonists.

IMPLICATIONS

Ketamine can be used safely in neurologically impaired patients under conditions of controlled ventilation, coadministration of a {gamma}-aminobutyric acid receptor agonist, and avoidance of nitrous oxide. Its beneficial circulatory effects and preclinical data demonstrating neuroprotection merit further animal and patient investigation.

α2-Adrenergic inhibition prevents the accompanied anticonvulsant effect of swim stress on behavioral convulsions induced by lithium and pilocarpine

There has been much debate regarding the potential influence of stress on epilepsy. Many studies have reported that stress can affect seizure susceptibility through eliciting either proconvulsant or anticonvulsant effects within the nervous system. In this study, we investigated the potential anticonvulsant effect of a 10-min swim stress on convulsions induced by a single systemic injection of lithium chloride followed 4 h later with pilocarpine. Rats pretreated with lithium chloride and exposed to a 10-min swim stressor prior to pilocarpine injection displayed a significant delay to seizure onset compared to unstressed rats or rats exposed to swim stress 10 min after lithium chloride, 2 h after lithium chloride, or immediately after pilocarpine injection. We then determined whether administration of a glucocorticoid antagonist (mifepristone; 10 or 50 mg/kg), an alpha(2)-adrenergic antagonist (yohimbine; 2 or 5 mg/kg), or a nonspecific opioid blocker (naloxone; 0.2 or 1 mg/kg) could prevent the anticonvulsant effect of swim stress. Only the high dose of yohimbine was capable of inhibiting the anticonvulsant effect of swim stress on lithium-pilocarpine seizures. Our findings highlight the importance of an endogenous noradrenergic-dependent anticonvulsant system in mediating the effects of swim stress on seizures. Further studies exploring the benefits of treatments with noradrenergic acting drugs in epilepsy is well warranted.