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Masala N, Pofahl M, Haubrich AN, Sameen Islam KU, Nikbakht N, Pasdarnavab M, Bohmbach K, Araki K, Kamali F, Henneberger C, Golcuk K, Ewell LA, Blaess S, Kelly T, Beck H. Targeting aberrant dendritic integration to treat cognitive comorbidities of epilepsy. Brain 2023; 146:2399-2417. [PMID: 36448426 PMCID: PMC10232249 DOI: 10.1093/brain/awac455] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/22/2023] Open
Abstract
Memory deficits are a debilitating symptom of epilepsy, but little is known about mechanisms underlying cognitive deficits. Here, we describe a Na+ channel-dependent mechanism underlying altered hippocampal dendritic integration, degraded place coding and deficits in spatial memory. Two-photon glutamate uncaging experiments revealed a marked increase in the fraction of hippocampal first-order CA1 pyramidal cell dendrites capable of generating dendritic spikes in the kainate model of chronic epilepsy. Moreover, in epileptic mice dendritic spikes were generated with lower input synchrony, and with a lower threshold. The Nav1.3/1.1 selective Na+ channel blocker ICA-121431 reversed dendritic hyperexcitability in epileptic mice, while the Nav1.2/1.6 preferring anticonvulsant S-Lic did not. We used in vivo two-photon imaging to determine if aberrant dendritic excitability is associated with altered place-related firing of CA1 neurons. We show that ICA-121431 improves degraded hippocampal spatial representations in epileptic mice. Finally, behavioural experiments show that reversing aberrant dendritic excitability with ICA-121431 reverses hippocampal memory deficits. Thus, a dendritic channelopathy may underlie cognitive deficits in epilepsy and targeting it pharmacologically may constitute a new avenue to enhance cognition.
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Affiliation(s)
- Nicola Masala
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
| | - Martin Pofahl
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
| | - André N Haubrich
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
| | - Khondker Ushna Sameen Islam
- Neurodevelopmental Genetics, Institute of Reconstructive Neurobiology, Medical Faculty, University of Bonn, 53127 Bonn, Germany
| | - Negar Nikbakht
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
| | - Maryam Pasdarnavab
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
| | - Kirsten Bohmbach
- Institute of Cellular Neurosciences, Medical Faculty, University of Bonn, 53127 Bonn, Germany
| | - Kunihiko Araki
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
| | - Fateme Kamali
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
| | - Christian Henneberger
- Institute of Cellular Neurosciences, Medical Faculty, University of Bonn, 53127 Bonn, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, 53127 Bonn, Germany
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Kurtulus Golcuk
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
| | - Laura A Ewell
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
- Department of Anatomy and Neurobiology, University of California, Irvine, CA 92697-3950, USA
- Center for the Neurobiology of Learning and Memory, University of California, Irvine, CA, 92697, USA
| | - Sandra Blaess
- Neurodevelopmental Genetics, Institute of Reconstructive Neurobiology, Medical Faculty, University of Bonn, 53127 Bonn, Germany
| | - Tony Kelly
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
| | - Heinz Beck
- Medical Faculty, Institute for Experimental Epileptology and Cognition Research, University of Bonn, 53127 Bonn, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen, 53127 Bonn, Germany
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Bayraktar E, Liu Y, Sonnenberg L, Hedrich UBS, Sara Y, Eltokhi A, Lyu H, Lerche H, Wuttke TV, Lauxmann S. In vitro effects of eslicarbazepine (S-licarbazepine) as a potential precision therapy on SCN8A variants causing neuropsychiatric disorders. Br J Pharmacol 2023; 180:1038-1055. [PMID: 36321697 DOI: 10.1111/bph.15981] [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: 08/20/2021] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Variants in SCN8A, the NaV 1.6 channel's coding gene, are characterized by a variety of symptoms, including intractable epileptic seizures, psychomotor delay, progressive cognitive decline, autistic features, ataxia or dystonia. Standard anticonvulsant treatment has a limited impact on the course of disease. EXPERIMENTAL APPROACH We investigated the therapeutic potential of eslicarbazepine (S-licarbazepine; S-lic), an enhancer of slow inactivation of voltage gated sodium channels, on two variants with biophysical and neuronal gain-of-function (G1475R and M1760I) and one variant with biophysical gain-of-function but neuronal loss-of-function (A1622D) in neuroblastoma cells and in murine primary hippocampal neuron cultures. These three variants cover the broad spectrum of NaV 1.6-associated disease and are linked to representative phenotypes of mild to moderate epilepsy (G1475R), developmental and epileptic encephalopathy (M1760I) and intellectual disability without epilepsy (A1622D). KEY RESULTS Similar to known effects on NaV 1.6 wildtype channels, S-lic predominantly enhances slow inactivation on all tested variants, irrespective of their particular biophysical mechanisms. Beyond that, S-lic exhibits variant-specific effects including a partial reversal of pathologically slowed fast inactivation dynamics (A1622D and M1760I) and a trend to reduce enhanced persistent Na+ current by A1622D variant channels. Furthermore, our data in primary transfected neurons reveal that not only variant-associated hyperexcitability (M1760I and G1475R) but also hypoexcitability (A1622D) can be modulated by S-lic. CONCLUSIONS AND IMPLICATIONS S-lic has not only substance-specific effects but also variant-specific effects. Personalized treatment regimens optimized to achieve such variant-specific pharmacological modulation may help to reduce adverse side effects and improve the overall therapeutic outcome of SCN8A-related disease.
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Affiliation(s)
- Erva Bayraktar
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Medical Pharmacology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yuanyuan Liu
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lukas Sonnenberg
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Neurobiology, University of Tübingen, Tübingen, Germany
| | - Ulrike B S Hedrich
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Yildirim Sara
- Department of Medical Pharmacology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmed Eltokhi
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Pharmacology, University of Washington, Seattle, Washington, USA
| | - Hang Lyu
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Thomas V Wuttke
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Stephan Lauxmann
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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Fei Y, Shi R, Song Z. Adjunctive Treatment With Eslicarbazepine Acetate for Adults and Children With Focal-Onset Epilepsy: A Meta-Analysis. Front Neurol 2022; 13:909471. [PMID: 35911890 PMCID: PMC9337800 DOI: 10.3389/fneur.2022.909471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe efficacy and tolerability of eslicarbazepine acetate (ESL) in adults and children with focal-onset epilepsy (FOE) according to the dose remain to be validated. A meta-analysis based on randomized controlled trials (RCTs) was therefore conducted as a summary.MethodsRelevant RCTs were collected by systematic searching the electronic databases of PubMed, Cochrane's Library, Embase, Wanfang and CNKI from inception to May 16, 2022. The random-effect model was adopted to pool the results by incorporating the possible heterogeneity. Efficacy outcomes including responsive rate and effective rate, defined as cases with 50 and ≥75% reduction in seizure frequency compared to baseline, were determined, respectively. Incidence of severe adverse events (AE) leading to drug discontinuation was also evaluated.ResultsTen studies including 2,565 people with epilepsy contributed to the meta-analysis. For adults, ESL 400 mg/d did not improve the response rate or the effective rate; ESL 800 mg/d was associated with improved response rate (odds ratio [OR] 2.16, 95% confidence interval [CI]: 1.65–2.83, p < 0.001) and effective rate (OR 2.16, 95% CI: 1.41–3.30, p < 0.001) without significantly increased severe AE (OR 1.58, 95% CI: 0.90–2.78, p = 0.11); ESL 1,200 mg/d improved response rate (OR 2.49, p < 0.001) and effective rate (OR 3.09, p = 0.04), but significantly increased severe AE (OR 3.72, p < 0.001). For children, ESL also did not significantly improve the response rate (OR 1.76, p = 0.22) or the effective rate (OR 2.17, p = 0.13).ConclusionESL 800 mg/d is effective and well-tolerated as adjuvants for adults with FOE. Efficacy of ESL in children with FOE should be further evaluated.
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Affiliation(s)
- Yanqing Fei
- Department of Neurology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Ruting Shi
- Department of Rehabilitation, Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhi Song
- Department of Neurology, Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Zhi Song
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