How valproate and phenytoin affect the ionic conductances and active transport characteristics of the crayfish giant axon

Epileptiform activity of veratridine model in rat brain slices: effects of antiepileptic drugs

The effects of the antiepileptic drugs valproic acid (VPA), phenytoin (PHT), and ethosuximide (ESM) on evoked and spontaneous seizure-like (epileptiform) activity were studied in the veratridine epileptiform model in rat brain slices, using conventional electrophysiological intracellular recording techniques. The veratridine model is generated by treatment of brain slices with a low concentration (0.3 microM) of the alkaloid veratridine. The drug modifies sodium channel function so that a brief current injection in hippocampal CA1 pyramidal neurons evokes bursts of epileptiform activity. Therapeutic concentrations of VAP (50-200 microM) inhibited both evoked and spontaneous bursting in a voltage-dependent manner without affecting membrane resting potential or input resistance. Similarly, therapeutic concentrations of PHT (4-15 microM) inhibited both evoked and spontaneous bursting in a voltage-dependent fashion with no apparent change in the membrane resting potential. However, PHT increased the membrane input resistance and elevated the firing threshold of neurons. The antiepileptic drug ESM failed to inhibit evoked or spontaneous bursting even at high concentrations. The results suggest that the veratridine model of epileptiform activity is sensitive only to antiepileptic drugs that primarily affect the sodium channels.

Valproic acid intensifies epileptiform activity in the hippocampal pyramidal neurons

The effects of large concentrations of valproic acid (VPA) on veratridine-induced epileptiform activity (veratridine model) were investigated in rat hippocampal CA1 pyramidal neurons. Studies were performed on the veratridine model in rat brain slices using conventional electrophysiological intracellular techniques. Large concentrations of VPA (5 mM or more) enhanced rather than inhibited epileptiform activity induced by veratridine. During the proepileptic phase of VPA, a membrane depolarization accompanied by a decrease in membrane input resistance were evident. The voltage-dependent proepileptic effect of VPA was blocked by tetrodotoxin (TTX; 100 nM) but not by the calcium channel blockers, diltiazem (5 microM) or omega-conotoxin GVIA (5 microM). VPA did not induce a proepileptic effect when it was superfused at high concentration (0.5-10 mM) on sodium channel-independent models such as the bicuculline or magnesium-free artificial cerebrospinal fluid. Large concentrations of VPA had no significant effect on untreated neurons. The VPA-enhanced veratridine bursting is probably related to the reported proepileptic activities observed in patients taking high doses of this drug. These data also suggest the involvement of sodium channels in the proepileptic effect of VPA.

Modelling of the pharmacodynamic interaction between phenytoin and sodium valproate

Treatment of epilepsy with a combination of antiepileptic drugs remains the therapeutic choice when monotherapy fails. In this study, we apply pharmacokinetic-pharmacodynamic modelling to characterize the interaction between phenytoin (PHT) and sodium valproate (VPA). Male Wistar rats received a 40 mg kg(-1) intravenous dose of PHT over 5 min either alone or in combination with an infusion of VPA resulting in a steady-state concentration of 115.5+/-4.9 microg ml(-1). A control group received only the infusion of VPA. The increase in the threshold for generalized seizure activity (ATGS) was used as measure of the anticonvulsant effect. PHT pharmacokinetics was described by a pharmacokinetic model with Michaelis-Menten elimination. The concentration-time course and plasma protein binding of PHT were not altered by VPA. The pharmacokinetic parameters Vmax and Km were, respectively, 294+/-63 microg min(-1) and 7.8+/-2.4 microg ml(-1) in the absence of VPA and 562+/-40 microg min(-1) and 15.6+/-0.9 microg ml(-1) upon administration in combination with VPA. A delay of the onset of the effect relative to plasma concentrations of PHT was observed. The assessment of PHT concentrations at the effect site was based on the effect-compartment model, yielding mean ke0 values of 0.128 and 0.107 min(-1) in the presence and absence of VPA, respectively. A nonlinear relationship between effect-site concentration and the increase in the TGS was observed. The concentration that causes an increase of 50% in the baseline TGS (EC50%TGS) was used to compare drug potency. A shift of EC50%TGS from 13.27+3.55 to 4.32+/-0.52 microg ml(-1) was observed upon combination with VPA (P<0.01). It is concluded that there is a synergistic pharmacodynamic interaction between PHT and VPA in vivo.

Effects of valproate on early and late potassium currents of single neurons

The effects of valproate sodium (VPA) on potassium currents were tested in identified neurons of the snail Helix pomatia. VPA was extracellularly and intracellularly applied. VPA (i) had no effects on the current-voltage relation of the early potassium outward current (IA), (ii) shifted the steady state inactivation function of IA to more positive potentials, (iii) increased the amplitude of the late potassium outward currents. It is suggested that the extrasynaptic effects on potassium currents markedly contribute to the antiepileptic and antimanic effects of VPA.

Sodium valproate decreases synaptic potentiation and epileptiform activity in hippocampus

The actions of sodium valproate (NaVP) were studied in the in vitro hippocampus using extracellular, intracellular and voltage-clamp recording techniques. In the CA1 region, concentrations of 30-200 microM NaVP reduced the amplitude but not the time course of post-tetanic potentiation (PTP) of dendritic field excitatory postsynaptic potentials (EPSPs). Epileptiform discharges were studied intracellularly in CA3 cells after pharmacological blockade of synaptic inhibition and repeated tetanic stimulation. NaVP (100 microM) blocked evoked paroxysmal depolarizing shift (PDS) discharges through a mechanism of increasing the threshold for burst-firing. When the PDS current was studied under voltage-clamp, application of NaVP (100 microM) resulted in a graded reduction of the PDS waveform. All of the actions of NaVP may result from inhibition of excitatory synaptic transmission following repetitive cell firing. A hypothesis is proposed that NaVP may act to decrease excitatory synaptic potentiation necessary for network synchronization.

Comparison of the effects of valproate, ethosuximide, phenytoin, and pentobarbital on cerebral energy metabolism in the rat

The acute effects of valproate (200 and 400 mg/kg), ethosuximide (200 and 400 mg/kg), phenytoin (25 and 50 mg/kg), and pentobarbital (30 and 60 mg/kg) on cerebral energy metabolism of rats were studied by measuring the cerebral content of energy metabolites and by evaluating the rate of metabolite utilization following decapitation. The treatments did not affect the levels of phosphocreatine (PCr), ATP, ADP, and AMP, but did enhance the glycogen or glucose stores. Pentobarbital induced a decrease in lactate, whereas valproate led to a decrease in pyruvate and an increase in lactate. Calculation of the metabolite fluxes after decapitation showed that all treatments delayed the rate of ATP utilization. The response was dose-dependent except with valproate. In addition, pentobarbital led to reductions in glucose utilization and lactate production, but the other drugs had no significant effect on glycolysis rate. The sparing effect on ATP utilization may be related to a membrane-stabilizing effect and may provide brain protection in case of excessive neuronal activation.

Phenytoin reduces calcium current in the cardiac Purkinje fiber

We have investigated the effects of phenytoin on the electrical and mechanical activity of isolated calf and dog cardiac Purkinje fibers. Phenytoin (5-100 microM) lowers and shortens the plateau phase of the Purkinje fiber action potential and reduces twitch tension. We studied the ionic basis of these effects by combining a conventional two-microelectrode voltage clamp procedure with pharmacological techniques that allow separation of time-dependent plateau membrane currents. We find that phenytoin reduces voltage-dependent calcium current in the Purkinje fiber. In addition, this drug slightly reduces two time-dependent outward currents. These effects of phenytoin on membrane current account, at least in part, for its influence on the action potential and twitch tension.

Calcium-dependent proteolysis in neural tissue is activated at physiologic intracellular Ca2+ levels and inhibited by some anticonvulsants

The level of calcium-activated neutral protease (CANP) activity in the brain and nerve cord of the crayfish Procambarus clarkii was assayed by measuring the degradation of casein yellow by tissue homogenates. When care was taken to maintain the ionic strength of all incubation media at 0.15M and to buffer the Ca2+ activity of the media with 5mM EGTA, CANP was found to be very sensitive to Ca2+; maximal activity was achieved at 1 X 10(-3)M Ca2+, with 50% of this maximum present at the physiologic intracellular Ca2+ activity of 1 X 10(-7)M. We found that the anticonvulsant agent phenytoin was without effect on CANP activity while pentobarbital and a relatively new anticonvulsant agent, valproic acid (an eight-carbon branched fatty acid), significantly inhibited CANP activity in a dose-dependent manner. The inhibitory effect of valproic acid was shared by a straight-chain eight-carbon fatty acid, caprylic acid. These findings demonstrate that inhibition of CANP activity is not limited to agents with a specific molecular structure. They also suggest that CANP plays a role in the normal turnover of proteins that control various cellular functions.

Depression of axonal excitability by valproate is antagonized by phenytoin

Standard electrophysiologic techniques were employed to determine the effects of the two anticonvulsants, valproic acid (VPA) and phenytoin (DPH), on the membrane excitability properties of the crayfish giant axon. VPA, 4 mM, produces a depolarization of the membrane that is associated with a decrease in the resting membrane conductance (gM). VPA also attenuates the increase in gNa and gK that are responsible for the depolarization and repolarization of the action potential; it decreases the magnitude, rate of depolarization and repolarization, and conduction velocity of the propagated action potential while increasing its duration. DPH has some effects on membrane properties that are qualitatively similar to those of VPA; 0.11 mM DPH also decreases gM, gNa, and gK. Unlike VPA, DPH does not have a significant effect on magnitude of either the resting or action potential. Pretreatment of axons with DPH reduces the effect of VPA on the magnitude, rate of depolarization and repolarization, and duration of the action potential while completely preventing the effects of VPA on resting potential, conduction velocity, and membrane conductance. These experiments and others on the effects of K(+) depolarization on membrane properties demonstrate that part, but not all, of the influence of VPA on the membrane is secondary to its depolarizing effect. The results reported here on a membrane model suggest at least part of the cellular basis for the anticonvulsant properties of VPA and DPH, alone and in combination.