Behavioral measures in animal studies: relevance to patients with epilepsy

Ultrasound stimulation inhibits recurrent seizures and improves behavioral outcome in an experimental model of mesial temporal lobe epilepsy

Current therapies for epilepsy consist mostly of pharmacological agents or invasive surgery. Recently, ultrasound (US) stimulation has been considered a promising tool for the noninvasive treatment of brain diseases, including epilepsy. However, in temporal lobe epilepsy (TLE), a common form of epilepsy, neurophysiological and functional outcomes following US stimulation are not well defined. To address this, we developed a paradigm of transcranial pulsed US stimulation to efficiently suppress seizure activity in the initial/acute period in a kainate (KA)-induced mouse model of mesial TLE. Pulsed US stimulation inhibited acute seizure activity and either delayed the onset of or suppressed status epilepticus (SE). Kainate-treated mice that had received US stimulation in the initial period exhibited fewer spontaneous recurrent seizures (SRSs) and improved performance in behavioral tasks assessing sociability and depression in the chronic period of epilepsy. Our results demonstrate that US stimulation in the acute period of epilepsy can inhibit SRSs and improve behavioral outcomes in a mouse model of mesial TLE. The present study suggests that noninvasive transcranial pulsed US stimulation may be feasible as an adjuvant therapy in patients with epilepsy. This article is part of a Special Issue entitled "Status Epilepticus".

Early deficits in social behavior and cortical rhythms in pilocarpine-induced mouse model of temporal lobe epilepsy

Many patients with epilepsy are afflicted with psychiatric comorbidities including social dysfunction. However, although social deficits have been a major concern in epilepsy treatment, the relationship between social behavioral pathogenesis and the time course of epileptogenesis is not well defined. To address this, we investigated social behavioral alterations and cortical rhythms during two distinct periods in a mouse model of temporal lobe epilepsy (TLE): 1) a seizure-free, latent period after status epilepticus and 2) the subsequent, chronic period characterized by spontaneous recurrent seizures (SRSs). We found that severe social impairments, such as reduced sociability/social novelty preference, social interaction, social learning, and enhanced defensiveness, appeared during the latent period in mice with TLE. The social dysfunctions in the latent-period mice were nearly comparable to those in the chronic-period mice. We also found that both the latent- and chronic-period mice showed similar aberrant neural activities. They showed enhanced delta-band (1-4 Hz) activity and reduced alpha- (8.5-12 Hz) and gamma-band (30-55 Hz) activity during baseline behavior. Interestingly, concomitant increases in alpha- and gamma-band activities during social behavior, which were characteristic in control mice, were not observed in either latent- or chronic-period mice. Our results indicate that social deficits and abnormal neural activities appear at an earlier stage in epileptogenesis regardless of SRS occurrence. These findings may help to understand behavioral pathogenesis in patients with TLE and at-risk patients with initial insults that develop into TLE.

Toward rational design of electrical stimulation strategies for epilepsy control

Electrical stimulation is emerging as a viable alternative for patients with epilepsy whose seizures are not alleviated by drugs or surgery. Its attractions are temporal and spatial specificity of action, flexibility of waveform parameters and timing, and the perception that its effects are reversible unlike resective surgery. However, despite significant advances in our understanding of mechanisms of neural electrical stimulation, clinical electrotherapy for seizures relies heavily on empirical tuning of parameters and protocols. We highlight concurrent treatment goals with potentially conflicting design constraints that must be resolved when formulating rational strategies for epilepsy electrotherapy, namely, seizure reduction versus cognitive impairment, stimulation efficacy versus tissue safety, and mechanistic insight versus clinical pragmatism. First, treatment markers, objectives, and metrics relevant to electrical stimulation for epilepsy are discussed from a clinical perspective. Then the experimental perspective is presented, with the biophysical mechanisms and modalities of open-loop electrical stimulation, and the potential benefits of closed-loop control for epilepsy.