Prenatal exposure to ionizing radiation and subsequent development of seizures

Early postnatal irradiation-induced age-dependent changes in adult mouse brain: MRI based characterization

Background

Brain radiation exposure, in particular, radiotherapy, can induce cognitive impairment in patients, with significant effects persisting for the rest of their life. However, the main mechanisms leading to this adverse event remain largely unknown. A study of radiation-induced injury to multiple brain regions, focused on the hippocampus, may shed light on neuroanatomic bases of neurocognitive impairments in patients. Hence, we irradiated BALB/c mice (male and female) at postnatal day 3 (P3), day 10 (P10), and day 21 (P21) and investigated the long-term radiation effect on brain MRI changes and hippocampal neurogenesis.

Results

We found characteristic brain volume reductions in the hippocampus, olfactory bulbs, the cerebellar hemisphere, cerebellar white matter (WM) and cerebellar vermis WM, cingulate, occipital and frontal cortices, cerebellar flocculonodular WM, parietal region, endopiriform claustrum, and entorhinal cortex after irradiation with 5 Gy at P3. Irradiation at P10 induced significant volume reduction in the cerebellum, parietal region, cingulate region, and olfactory bulbs, whereas the reduction of the volume in the entorhinal, parietal, insular, and frontal cortices was demonstrated after irradiation at P21. Immunohistochemical study with cell division marker Ki67 and immature marker doublecortin (DCX) indicated the reduced cell division and genesis of new neurons in the subgranular zone of the dentate gyrus in the hippocampus after irradiation at all three postnatal days, but the reduction of total granule cells in the stratum granulosun was found after irradiation at P3 and P10.

Conclusions

The early life radiation exposure during different developmental stages induces varied brain pathophysiological changes which may be related to the development of neurological and neuropsychological disorders later in life.

Prenatal irradiation-induced brain neuropathology and cognitive impairment

Embryo/fetus is much more radiosensitive than neonatal and adult human being. The main potential effects of pre-natal radiation exposure on the human brain include growth retardation, small head/brain size, mental retardation, neocortical ectopias, callosal agenesis and brain tumor which may result in a lifetime poor quality of life. The patterns of prenatal radiation-induced effects are dependent not only on the stages of fetal development, the sensitivity of tissues and organs, but also on radiation sources, doses, dose rates. With the increased use of low dose radiation for diagnostic or radiotherapeutic purposes in recent years, combined with postnatal negative health effect after prenatal radiation exposure to fallout of Chernobyl nuclear power plant accident, the great anxiety and unnecessary termination of pregnancies after the nuclear disaster, there is a growing concern about the health effect of radiological examinations or therapies in pregnant women. In this paper, we reviewed current research progresses on pre-natal ionizing irradiation-induced abnormal brain structure changes. Subsequent postnatal neuropsychological and neurological diseases were provided. Relationship between irradiation and brain aging was briefly mentioned. The relevant molecular mechanisms were also discussed. Future research directions were proposed at the end of this paper. With limited human data available, we hoped that systematical review of animal data could relight research interests on prenatal low dose/dose rate irradiation-induced brain microanatomical changes and subsequent neurological and neuropsychological disorders.

Prenatal exposures associated with neurodevelopmental delay and disabilities

Neurobehavioral teratology refers to the study of the abnormal development of the structure and the behavioral functions of the central nervous system, which result from exposure to exogenous agents during prenatal development. The focus of this review is the effects of various prenatal exposures on human neurodevelopment. Studies that deal with the adverse effects of infectious agents (rubella, cytomegalovirus, and toxoplasma), teratogenic drugs (e.g., antiepileptic drugs such as phenytoin, valproate, and carbamazepine, coumarin derivatives, and retinoids), alcohol, and other substances of abuse will be reviewed. Additionally, prenatal exposure to industrial or environmental chemicals (e.g., lead, methylmercury, and polycarbonated biphenyls) as well as exposure of the embryo or fetus to high amounts of ionizing radiation will be addressed. Possible mechanisms of selected neurobehavioral teratogens will also be discussed.

Management of glioblastoma multiforme in pregnancy

Glioblastoma multiforme presenting during pregnancy presents unique challenges to the clinician. In planning treatment, potential benefits to the mother must be balanced against the risks to the fetus. In addition, evidence relating to timing of surgery and the use of radiotherapy and chemotherapy in pregnancy is limited. Management of peritumoral edema and seizures in pregnancy is also complicated by the potential for drug-related teratogenic effects and adverse neonatal outcomes on the fetus. The general anesthetic used for surgery must factor obstetric and neurosurgical considerations.

In this review article, the authors seek to examine the role, safety, and timing of therapies for glioblastoma in the context of pregnancy. This covers the use of radiotherapy and chemotherapy, timing of surgery, postoperative care, anesthetic considerations, and use of anticonvulsant medications and steroids. The authors hope that this will provide a framework for clinicians treating pregnant patients with glioblastomas.

Long-term radiation-related health effects in a unique human population: lessons learned from the atomic bomb survivors of Hiroshima and Nagasaki

For 63 years scientists in the Atomic Bomb Casualty Commission and its successor, the Radiation Effects Research Foundation, have been assessing the long-term health effects in the survivors of the atomic bombings of Hiroshima and Nagasaki and in their children. The identification and follow-up of a large population (approximately a total of 200,000, of whom more than 40% are alive today) that includes a broad range of ages and radiation exposure doses, and healthy representatives of both sexes; establishment of well-defined cohorts whose members have been studied longitudinally, including some with biennial health examinations and a high survivor-participation rate; and careful reconstructions of individual radiation doses have resulted in reliable excess relative risk estimates for radiation-related health effects, including cancer and noncancer effects in humans, for the benefit of the survivors and for all humankind. This article reviews those risk estimates and summarizes what has been learned from this historic and unique study.

Unraveling the fundamental molecular mechanisms of morphological and cognitive defects in the irradiated brain

Prenatal radiation exposure may have serious consequences for normal brain development. Results of epidemiological studies clearly pointed towards an increased risk of mental retardation in children of the surviving women of the Hiroshima/Nagasaki atomic bombing when in utero exposure had occurred between weeks 8 and 15 of pregnancy or, at a lower extend between weeks 15 and 25. The high sensitivity of the developing brain, in comparison to the adult brain is related to its higher number of non-differentiated, dividing neural precursor cells. Exposure of the developing brain to ionizing radiation can lead to three main outcomes in the developing brain, depending on the radiation dose and the elapsed period after irradiation. A first event occurs early after irradiation and triggers disturbances in cell proliferation, migration, differentiation, and cell death. A second event involves the generation of morphological abnormalities in the developing brain, if the radiation dose is sufficient. A third event involves cognitive dysfunctions that are a direct consequence from a disturbance in regional brain formation. The latter results from exposure to low doses and is usually only observed in the later period of development. In order to understand the mechanisms of radiation-induced cognitive dysfunctions, it is important to track back the underlying changes in specific molecular pathways. In this review, we present the possible relationships within and between molecular pathways potentially involved in cognitive dysfunctions induced by ionizing radiation in the developing brain.

Radiation as a Nervous System Toxin

Neurotoxicity from radiation can range widely and produce effects that may include (1) small absolute increases in cancer risks, (2) subtle effects on higher level functioning in some individuals, (3) severe cognitive impairment in some individuals, (4) severe focal injury tat may include necrosis or irreversible loss of function, and (5) overwhelming and rapidly fatal diffuse injury associated with high-dose, whole-body exposures. An understanding of the implications of nervous system exposure to radiation can guide efforts in radiation protection and aid in the optimization of the medical uses of radiation.

Severity of Histopathologic Abnormalities and In Vivo Epileptogenicity in the In Utero Radiation Model of Rats Is Dose Dependent

PURPOSE

Malformations of cortical development (MCDs) are a frequent cause of refractory epilepsy in humans. The in utero radiation model in rats shares many clinical and histopathologic characteristics with human MCDs. Previous studies reported the presence of clinical seizures in radiated rats, but also suggested a dose-dependent differential effect.

METHODS

Time-pregnant Sprague-Dawley rats were irradiated on embryonic day E17 with 100 cGy (low dose), 145 cGy (medium dose), 175 cGy (high dose), or were left untreated. Their adult litters were implanted with bifrontal epidural and hippocampal depth electrodes and underwent long-term video-EEG monitoring. After 2 weeks of monitoring, the animals were killed and their brains processed for histological studies.

RESULTS

Spikes were most frequently found in the rats that were subjected to low- and medium-dose radiation at E17 and were less frequently seen in the animals that were subjected to high-dose radiation. No interictal spikes were found in any of the control animals. Seizures were recorded in three of five animals of the medium-dose group. Histological studies showed a dose-dependent decrease in cortical thickness as well as an increase of cortical and hippocampal disorganization.

CONCLUSIONS

In vivo epileptogenicity in radiated animals was present only in mild or moderate MCD. No in vivo epileptogenicity was seen in severe radiation-induced MCD.

How radiosensitive are the developing embryo and fetus?

In its 1990 recommendations, the ICRP considered the radiation risks after exposure during prenatal development. This report is a critical review of new experimental animal data on biological effects and evaluations of human studies after prenatal radiation published since the 1990 recommendations.

Thus, the report discusses the effects after radiation exposure during pre-implantation, organogenesis, and fetogenesis. The aetiology of long-term effects on brain development is discussed, as well as evidence from studies in man on the effects of in-utero radiation exposure on neurological and mental processes. Animal studies of carcinogenic risk from in-utero radiation and the epidemiology of childhood cancer are discussed, and the carcinogenic risk to man from in-utero radiation is assessed. Open questions and needs for future research are elaborated.

The report reiterates that the mammalian embryo and fetus are highly radiosensitive. The nature and sensitivity of induced biological effects depend upon dose and developmental stage at irradiation. The various effects, as studied in experimental systems and in man, are discussed in detail. It is concluded that the findings in the report strengthen and supplement the 1990 recommendations of the ICRP.

Nuclear terrorism

Recent events have heightened awareness of the potential for terrorist attacks employing nonconventional weaponry such as biological agents and radiation. Historically, the philosophy of nuclear risk has focused on global or strategic nuclear exchanges and the resulting damage from large-scale releases. Currently, nuclear accidents or terrorist attacks involving low-level or regional release of radiation are considered the most likely events. Thus far, there have been several regional radiation incidents exposing hundreds of thousands of people to radiation, but there have been only a limited number of significant contaminations resulting in death. There are several different types of radioactive particles that differ in mass, extent of radiation emitted, and the degree to which tissue penetration occurs. Radiation affects its toxicity on biological systems by ionization, which creates tissue damage by the generation of free radicals, disruption of chemical bonds, and directly damaging cellular DNA and enzymes. The extent of damage depends on the type of radioisotope and the radiation dose. Radiation doses exceeding 2 to 10 Gy are considered lethal. Optimal management of radiation casualties requires knowledge of the type and dose of radiation received, a recognition of the manifestations of radiation sickness, and the use of standard medical care, decontamination, and decorporation techniques.

Electroencephalographic characterization of an adult rat model of radiation-induced cortical dysplasia

PURPOSE

Cortical dysplasia (CD) is a frequent cause of medically intractable focal epilepsy. The mechanisms of CD-induced epileptogenicity remain unknown. The difficulty in obtaining and testing human tissue warrants the identification and characterization of animal model(s) of CD that share most of the clinical, electroencephalographic (EEG), and histopathologic characteristics of human CD. In this study, we report on the in vivo EEG characterization of the radiation-induced model of CD.

METHODS

Timed-pregnant Sprague-Dawley rats were irradiated on E17 using a single dose of 145 cGy or left untreated. Their litters were identified and implanted with bifrontal epidural and hippocampal depth electrodes for prolonged continuous EEG recordings. After prolonged EEG monitoring, animals were killed and their brains sectioned and stained for histologic studies.

RESULTS

In utero-irradiated rats showed frequent spontaneous interictal epileptiform spikes and spontaneous seizures arising independently from the hippocampal or the frontal neocortical structures. No epileptiform or seizure activities were recorded from age-matched control rats. Histologic studies showed the presence of multiple cortical areas of neuronal clustering and disorganization. Moreover, pyramidal cell dispersion was seen in the CA1>CA3 areas of the hippocampal formations.

CONCLUSIONS

Our results further characterize the in vivo EEG characteristics of the in utero radiation model of CD using long-term EEG monitoring. This model may be used to study the molecular and cellular changes in epileptogenic CD and to test the efficacy of newer antiepileptic medications.

Cognitive function and prenatal exposure to ionizing radiation

It is clear from the many studies of the prenatally exposed survivors of the atomic bombing of Hiroshima and Nagasaki that exposure to ionizing radiation during gestation has harmful effects on the developing human brain, particularly if that exposure occurs at critical stages in the development of the neocortex. Data on a variety of measures of cognitive function, including the occurrence of severe mental retardation as well as variation in the intelligence quotient (IQ) and school performance, show significant effects on those survivors exposed 8-15 weeks and 16-25 weeks after ovulation. Studies of seizures, primarily those without known precipitating cause, also exhibit a radiation effect on those individuals exposed in the first 16 weeks after ovulation. The cellular and molecular events that subtend these abnormalities are still largely unknown although some progress toward an understanding has occurred. For example, magnetic resonance imaging of the brain of some of the mentally retarded survivors has revealed a large region of abnormally situated gray matter, suggesting an abnormality in neuronal migration, but cell killing could also contribute importantly to the effects on cognitive function that have been seen. The retardation of growth in stature observed in individuals exposed in the first and second trimesters of pregnancy suggests that the development of an atypically small head size, without conspicuously impaired cognitive function, may reflect a generalized retardation of growth.

Radiation-related brain damage and growth retardation among the prenatally exposed atomic bomb survivors

Many studies of prenatally exposed survivors of the atomic bombings of Hiroshima and Nagasaki have shown that exposure to ionizing radiation during gestation has harmful effects on the developing human brain. Data on the occurrence of severe mental retardation as well as variation in intelligence quotient (IQ) and school performance show significant effects on those survivors exposed 8-15 and 16-25 weeks after ovulation. Studies of seizures, especially those without a known precipitating cause, also exhibit a radiation effect in survivors exposed 8-15 weeks after ovulation. The biologic events that subtend these abnormalities are still unclear. However, magnetic resonance imaging of the brains of some mentally retarded survivors has revealed a large region of abnormally situated gray matter, suggesting an abnormality in neuronal migration. Radiation can induce small head size as well as mental retardation, and a review of the relationship between small head size and anthropometric measurements, such as height, weight, sitting height and chest circumference, shows that individuals with small head size have smaller anthropometric measurements than normocephalics. This suggests that radiation-related small head size is related to a generalized growth retardation. Finally, the issue of a threshold in the occurrence of one or more of these effects, both heuristically and from a regulatory perspective, remains uncertain. Simple inspection of the data often suggests that a threshold may exist, but little statistical support for this impression can be advanced, except in the instance of mental retardation.

Brain damage among individuals exposed prenatally to ionizing radiation: a 1993 review

Mental retardation as a result of prenatal exposure to ionizing radiation is not a common phenomenon when compared to the incidence of cancer, but it has nevertheless been well-documented. This article describes results from studies of individuals who were exposed prenatally to radiation in Hiroshima and Nagasaki. The critical time of exposure, when the most significant damage was done, was during the 8th-15th week of gestation, with a lesser effect at 16-25 weeks. Individuals in the study were assessed by measurement of an intelligence quotient and by examination of school performance. Studies show that the period of 8-15 weeks of gestation coincides with a key time for neuronal cell migration in the developing brain. There is continuing investigation of the mechanism of this migration and how it might be disrupted by ionizing radiation.

Hazards of ionising radiation: 100 years of observations on man

In November 1895, when Conrad Röntgen serendipitously discovered X-rays, epidemiology was effectively limited to the study of infectious disease. What little epidemiological work was done in other fields was done as part of clinical medicine or under the heading of geographical pathology. The risks from exposure to X-rays and subsequently from other types of ionising radiation were consequently discovered by qualitative association or animal experiment. They did not begin to be quantified in humans until half a century later, when epidemiology emerged as a scientific discipline capable of quantifying risks of non-infectious disease and the scientific world was alerted to the need for assessing the effects of the radiation to which large populations might be exposed by the use of nuclear energy in peace and war.

Further observations on abnormal brain development caused by prenatal A-bomb exposure to ionizing radiation

The pervasiveness of abnormal brain development caused by prenatal exposure to ionizing radiation is still largely unknown. The relationship between A-bomb radiation dose and two measures of neuromuscular performance, one of grip strength and the other of the fine motor coordination required in repetitive action, is described. A multivariate analysis of covariance was used to evaluate the effect of several covariates, such as prenatal radiation exposure and some physical measurements or IQ adding city and sex as categorical factors. When mentally retarded cases were included, a statistically significant effect of radiation exposure on the grip strength and repetitive-action test scores was seen in the 8-15-week postovulation period, and a statistically suggestive effect at 16-25 weeks postovulation. No effect of radiation exposure on the two test scores was noted for prenatal exposure in either of the aforementioned periods when mentally retarded cases were excluded, but a statistically significant diminution of IQ was noted for exposures > or = 16 weeks postovulation. We discuss, from the biological perspective, the projected standard scores for exposures > or = 16 weeks postovulation, and the possibility of lower IQ, small head and mild mental retardation related to radiation exposures < or = 15 weeks postovulation with mentally retarded cases excluded.