Effects of seizures, kindling, and carbamazepine on sleep organization in cats

The diagnostic value of sleep-deprived EEG in epilepsy: A meta-analysis

Sleep deprivation has been studied as a method to induce sleep before EEG testing to improve the diagnosis of epilepsy. However, the effectiveness of sleep deprivation in diagnosing epilepsy through EEG in humans showed conflicting findings in previous studies. This meta-analysis aimed to provide statistical evidence for the diagnostic value of sleep-deprived EEG in epilepsy. A systematic search of the Web of Science and PubMed databases identified 12 relevant studies from May 1997 to the present. These studies were included to examine the diagnostic value of sleep-deprived EEG in epilepsy and its associated clinical variables, such as patient age, duration of sleep deprivation, and EEG recording duration. The results of the random effects model did not show a significant overall diagnostic effect for sleep-deprived EEG in epilepsy, but revealed high heterogeneity among the studies. Notably, this heterogeneity was not accounted for by the clinical variables analyzed. Upon excluding outliers, a trend suggesting a modest diagnostic value of sleep-deprived EEG emerged. The high heterogeneity among studies indicates the need for a standardized protocol for sleep deprivation in future studies. Overall, while sleep deprivation may have a small positive effect on EEG-based epilepsy diagnosis, further research is needed to better understand its impact and optimize its use in clinical practice.

Decoding Circadian Rhythm and Epileptic Activities: Clues From Animal Studies

The relationship between circadian rhythm and epilepsy has been recognized for decades. Yet many questions underlying the complex mechanisms of their interaction remain elusive. A better understanding on this topic allows the development of accurate seizure-detection algorithm and alternative precise therapeutic strategies. Preclinical laboratory studies based on epileptic animal models, with controllable epileptogenic pathology and an array of intervention strategies, shed light on the bidirectional effects between circadian rhythm and epileptic seizures as well as their underlying mechanisms. Here, we reviewed findings on the interaction between circadian rhythm and epileptic seizures in the preclinical setting. We present the possible mechanisms at molecular, cellular and circuitry levels. We propose that future experimental designs should take into account the relationship between circadian rhythm and epilepsy as well as the underlying mechanisms in different types of animal models, which may have a translational significance as stepping stones for clinical benefits.

Effect of oxcarbazepine on sleep architecture

The most common side effects following administration of antiepileptic drugs involve alterations in sleep architecture and varying degrees of daytime sleepiness. Oxcarbazepine is a drug that is approved as monotherapy for the treatment of partial seizures and generalized tonic-clonic seizures. However, there is no information about its effects on sleep pattern organization; therefore, the objective of this work was to analyze such effects. Animals (Wistar rats) exhibited three different behavioral and electrophysiological states of vigilance: wakefulness, slow wave sleep (SWS), and rapid eye movement (REM) sleep. Oral treatment with oxcarbazepine (100 mg/kg) produced an increment in total sleep time throughout the recording period. This increment involved both SWS and REM sleep. Mean duration of the REM sleep phase was not affected. In contrast, the frequency of this sleep phase increased significantly across the 10-hour period. REM sleep latency shortened significantly. Results obtained in this work indicate that oxcarbazepine's acute effects point to hypnotic properties.

Pentylenetetrazole Kindling Affects Sleep in Rats

PURPOSE

The aim of the study was to define sleep disturbances in pentylenetetrazole (PTZ)-kindled rats and to explore the effects of the nootropic drug piracetam (Pir; 100 mg/kg) and the noncompetitive N-methyl-D-aspartate (NMDA)-antagonist MK-801 (0.3 mg/kg), which normalized learning performance in PTZ-kindled rats, on altered sleep parameters.

METHODS

This is the first report showing a significant reduction in paradoxical sleep (PS) as a consequence of PTZ kindling. A correlation analysis revealed a significant correlation between seizure severity and PS deficit.

RESULTS

Pir did not interfere with seizure severity, and the substance did not ameliorate the PS deficit. However, the substance disconnected the correlation between seizure severity and PS deficit. MK-801, which reduced the severity of kindled seizures, counteracted the PS deficit efficaciously.

CONCLUSIONS

The results suggest that seizure severity and alterations in sleep architecture are two factors in the comprehensive network underlying learning impairments associated with epilepsy. Considering the results obtained in the experiments with Pir, reduction of seizure severity does not guarantee the reduction of impairments in the domain of learning.

Kindling Limits the Interictal Neuronal Temporal Response Properties in Cat Primary Auditory Cortex

PURPOSE

The present study examined the effect of electrical kindling on the interictal temporal response properties of single units recorded from primary auditory cortex (AI) of the adult cat.

METHODS

Cats were permanently implanted with electrodes in AI, kindled twice daily for 40 sessions, and the contralateral AI was subsequently mapped. Kindling stimulation consisted of 1-s trains of biphasic square-wave pulses applied at a frequency of 60 Hz, 100 microA above the afterdischarge (AD) threshold. The EEG activity was recorded during each kindling session, and the behavioral manifestation was scored. Subsequent to kindling, multiple single-unit responses were recorded under ketamine anesthesia in response to 1-s-long periodic click trains, with click rates between 2 and 64 Hz. Neuronal responses were characterized according to their ability to respond in time-locked fashion to the clicks.

RESULTS

Kindling stimulation resulted in progression of the AD characteristics and seizure behavior, with six of 10 kindled cats reaching a fully generalized state. In the fully kindled cats, the best modulation frequencies and limiting following rates for the single-unit responses were significantly lower compared with those of naive and sham controls.

CONCLUSIONS

Repeated epileptiform activity interferes with temporal processing in cat auditory cortex in the interictal state. This may have implications for people with epileptic foci in auditory-related areas.

Single neuron burst firing in the human hippocampus during sleep

Although there are numerous non-primate studies of the single neuron correlates of sleep-related hippocampal EEG patterns, very limited hippocampal neuronal data are available for correlation with human sleep. We recorded human hippocampal single neuron activity in subjects implanted with depth electrodes required for medical diagnosis and quantitatively evaluated discharge activity from each neuron during episodes of wakefulness (Aw), combined stage 3 and 4 slow-wave sleep (SWS), and rapid eye movement (REM) sleep. The mean firing rate of the population of single neurons was significantly higher during SWS and Aw compared with REM sleep (p = 0.002; p < 0.0001). In addition, burst firing was significantly greater during SWS compared with Aw (p = 0.001) and REM sleep (p < 0.0001). The synchronized state of SWS and associated high-frequency burst discharge found in human hippocampus may subserve functions similar to those reported in non-primate hippocampus that require burst firing to induce synaptic modifications in hippocampal circuitry and in hippocampal projections to neocortical targets that participate in memory consolidation.

Sleep states differentiate single neuron activity recorded from human epileptic hippocampus, entorhinal cortex, and subiculum

Animal models of epilepsy have shown that synchronous burst firing is associated with epileptogenesis, yet the evidence from human studies linking neuronal synchrony and burst firing to epileptogenesis remains equivocal. Sleep-wake states have been shown to differentially modulate the generation of epileptiform EEG spikes between brain regions of greater and lesser seizure-generating potential, providing information that helps to identify the primary epileptogenic region. Using these state-dependent mechanisms to assist us in identifying neuronal correlates of human epilepsy, we recorded interictal neuronal activity from mesial temporal lobe (MTL) areas in epileptic patients implanted with depth electrodes required for medical diagnosis during polysomnographically defined sleep-wake states. Results show that single neurons recorded ipsilateral to seizure-initiating MTL ("epileptic") areas had significantly higher firing rates (p = 0.01) and burst propensity (p = 0.01) and greater synchrony of discharges (p = 0.003) compared with neurons recorded from contralateral non-seizure-generating MTL ("non-epileptic") areas. In particular, during episodes of slow wave sleep (SWS) and rapid eye movement (REM) sleep, epileptic hippocampal neurons had significantly higher burst rates compared with non-epileptic hippocampal neurons (both p = 0.01). In contrast, during episodes of wakefulness (Aw), no difference in burst firing between epileptic and non-epileptic hippocampal neurons was observed. Furthermore, synchronous firing was significantly higher between epileptic MTL neurons compared with non-epileptic MTL neurons during SWS (p = 0.04) and REM sleep (p = 0.02), but no difference in neuronal synchrony was found between epileptic and non-epileptic neurons during Aw. These results provide evidence that sleep states differentially modulate abnormal epileptogenic neuronal discharge properties within human MTL and confirm that neuronal burst firing and enhanced neuronal synchrony observed in experimental animal models of epilepsy characterizes human epilepsy as well.

Seizure susceptibility decreases with enhancement of rapid eye movement sleep

The study examined the effect of enhanced rapid eye movement (REM) sleep duration on the seizure threshold determined by electrical stimulation of the amygdala in rats. The duration of REM sleep was specifically increased by the microinjection of a cholinergic agonist, carbachol, into the pontine reticular formation. This was accompanied by a significant increase in the threshold current required to elicit an afterdischarge in the amygdala. The results suggest that an increase in REM sleep decreases the likelihood of cortical seizure activity, an effect that is manifest even in other stages of the sleep-wakefulness cycle and not only in the REM state, per se.

Long-lasting effects of feline amygdala kindling on monoamines, seizures and sleep

This report describes the relationship between monoamines, sleep and seizures before and 1-month after amygdala kindling in young cats (<1 year old; n=8; six female and two male). Concentrations (fmoles of norepinephrine or NE, dopamine or DA and serotonin or 5-HT) were quantified in consecutive, 5-min microdialysis samples (2 microl/min infusion rate) from amygdala and locus ceruleus complex (LC) during four, 6-8-h polygraphic recordings before (n=2) and 1 month post-kindling (n=2); 5-min recording epochs were temporally adjusted to correspond to dialysate samples and differentiated according to dominant sleep or waking state (lasting > or =80% of 5-min epoch) and degree of spontaneous seizure activity (number and duration of focal versus generalized spikes and spike trains and behavioral seizure correlates). Post-kindling records in each cat were divided into two groups (n=1 record each) based on higher or lower spontaneous EEG and behavioral seizure activity and compared to pre-kindling records. We found: (1) before and after kindling, NE and 5-HT but not DA concentrations were significantly lower in sleep than waking at both sites; (2) after kindling, each cat showed cyclic patterns, as follows: (a) higher NE, 5-HT and DA concentrations accompanied increased seizure activity with delayed sleep onset latency and increased sleep fragmentation (reduced sleep state percentages, number of epochs and/or epoch duration) in one recording versus (b) lower monoaminergic concentrations accompanied reduced seizure activity, rapid sleep onset and reduced sleep disruption in the other recording. The alternating, post-kindling pattern suggested "rebound" effects which could explain some controversies in the literature about chronic effects of kindling on monoamines and sleep-waking state patterns.

Effect of antiepileptic drugs on sleep

The interactions between sleep and epilepsy are well known. A nodal point of the relationship between sleep and epilepsy is represented by pharmacological treatment. Sleep disturbances such as drowsiness are among the most frequent side effects of treatment with antiepileptic drugs, since they can deeply modify both sleep architecture and the sleep-wake cycle. Severe daytime somnolence affects patients' activities and it may facilitate the occurrence of seizures. These considerations underline the importance of antiepileptic drugs having anticonvulsant properties that do not negatively influence sleep and daytime somnolence. In this paper we review some relevant aspects of the effects of antiepileptic drugs on sleep.

Sleep and EEG interictal epileptiform abnormalities in partial epilepsy

The relationship between sleep and EEG interictal epileptiform abnormalities (IEA) has been studied from different perspectives. One of the most followed orientations regards the investigation of the effects of IEA on sleep organization, while another approach considers the modulation of IEA caused by sleep. Only the latter approach, for its practical diagnostic implications, is covered by the present review. In particular, on the basis of the literature and of personal studies, we review some relevant aspects of the relationship between the different stages of the sleep and the EEG epileptic abnormalities in partial epilepsy. In addition, the modulation of IEA by fluctuations of the level of arousal and by sleep microstructure is reviewed. Finally, the information obtained on localization of epileptic foci from recordings during wakefulness and different sleep stages is discussed.

Effects of vigabatrin on sleep-wakefulness cycle in amygdala-kindled rats

PURPOSE

Our aim was to study the effect of prolonged administration of vigabatrin (VGB) on sleep-wakefulness cycle in kindled seizure-induced rats.

METHODS

Adult male Wistar rats were implanted stereotaxically with electrodes for kindling and polysomnography. The rats were divided into two groups, kindled and VGB-treated kindled rats. VGB was administered intraperitonially every day for 21 days, and polysomnographic recordings were taken after doses 1, 7, 14, and 21. The drug effects were evaluated by comparing the records of kindled and drug-treated kindled rats.

RESULTS

The VGB-administered kindled rats showed an increase in total sleep time (TST) due to an increase in total non-rapid eye movement (NREM) and light slow-wave sleep stage I (SI) with a decrease in wakefulness. The number of episodes and REM onset latencies were found to be decreased after drug treatment.

CONCLUSIONS

It can therefore be concluded that VGB has a somnolence-inducing effect and that it might mediate its anticonvulsant effect by altering sleep architecture through sleep-regulating areas.

Effects of repeated seizure induction on seizure activity, post-ictal and interictal behavior

Individual variability and numerous interactions between pharmacokinetics, pharmacodynamics, and homeostatic factors complicate the study of the anticonvulsant effect in animal models of seizure activity. In theory, both individual variability and the contribution of these factors to the anticonvulsant effect can be determined by following the time course of the pharmacological response and the corresponding plasma concentrations in individual animals. Currently, there are several formal pharmacokinetic-pharmacodynamic models available for the analysis of such data, which yield accurate estimates of drug intrinsic activity and potency. However, most models of seizure activity are not suited for such an approach, either because they can be applied only once, or because the expression of seizures is not constant over time. In addition, the induction of seizures constitutes repeated jeopardy to the animals, which may profoundly change behavior and interfere in the anticonvulsant response as well as in different physiological processes. In this paper, we compare ictal, post-ictal, and interictal behavior in three different models of seizure activity in rats, namely, the electroconvulsive shock, amygdala kindling and the cortical stimulation model (CSM). The methods were compared in the same way as they are currently in use for the assessment of antiepileptic drug effect. Our results show that repeated seizure activity induced by cortical stimulation does not exacerbate ictal activity (eye closure, jerk, gasp, forelimb clonus, and hind-limb tonus) nor post-ictal behavior (chewing and freezing), while producing less serious changes in interictal behavior (walk, lean, upright rearing, exploratory, grooming, and rest) than kindling or electroconvulsive shock. We conclude that seizures induced by cortical stimulation are reproducible and qualitatively similar to kindling seizures. Our results also suggest that the electroconvulsive shock model is not suited for pharmacokinetic-pharmacodynamic studies and that the assessment of interictal behavior may contribute to the evaluation of overall antiepileptic drug effect in seizure disorders.

Sleep-wakefulness alterations in amygdala-kindled rats

PURPOSE

Our aim was to study the relation between epilepsy and sleep-wakefulness cycles in the amygdala-kindling model of temporal lobe epilepsy.

METHODS

Adult male Wistar rats were electrically kindled through bipolar electrodes implanted in the anterior amygdala. Polysomnographic recordings were taken before and after kindled seizures for 6 h. For the studies on the effects of a single, full-blown seizure, recordings were taken immediately after the seizure and daily thereafter until the recordings returned to baseline values. For studies on the effects of five full-blown seizures, recordings were taken immediately after the fifth seizure and then on day 1, 2, 3, 5, 7, 14, 21, and 28.

RESULTS

Polysomnographic recordings taken immediately after the first full-blown seizure revealed an initial increase in the duration of deep slow-wave sleep (SII), a decrease in the light slow-wave sleep (SI) stage of non-rapid eye movement (NREM) sleep, and a decrease in the quiet wakefulness (W2) stage of wakefulness. All these parameters returned to baseline values after 24 h. The duration of rapid eye movement (REM) sleep increased and returned to the baseline value after 48 h. Five consecutive full-blown seizures caused an increase in the duration of SII from the day the seizures occured until day 28, whereas the duration of SI decreased for 72 h. The duration of REM sleep, decreased only on the day of the seizures and day 1, while decreases in the number of REM episodes were observed on the day of the seizure, day 2 and day 14.

CONCLUSIONS

Our study indicates that even a single, full-blown seizure can cause alterations in the architecture of sleep-wakefulness cycles for a short duration, and that multiple seizures produce long-term effects.

Nocturnal sleep and daytime somnolence in untreated patients with temporal lobe epilepsy: changes after treatment with controlled-release carbamazepine

PURPOSE

To define sleep disturbances in patients with temporal lobe epilepsy (TLE) and explore the association between carbamazepine (CBZ) therapy, sleep, and daytime somnolence.

METHODS

We recorded nocturnal polysomnography and measured subjective and objective daytime somnolence in a group of newly diagnosed TLE patients, who had no evidence of anatomic brain lesion on neuroimaging and had never been treated before. Recordings were performed at baseline, after the initial administration of 400 mg CBZ-controlled release (CR) and after 1 month of treatment (400 mg twice daily b.i.d.). The findings were compared with those of a group of young healthy volunteers, both at baseline and after the first administration of CBZ. The chronic effect of CBZ-CR treatment was evaluated only in TLE patients.

RESULTS

At baseline, nocturnal sleep patterns of TLE patients did not show marked alterations when the influence of seizures, cerebral lesions, and drugs had been ruled out. In both the TLE and the control groups, initiation of CBZ therapy provoked a reduction and a fragmentation of rapid eye movement (REM) sleep and an increase in the number of sleep stage shifts. In the TLE group, these effects were almost completely reversed after 1 month of treatment, and no significant difference was noted between baseline condition and long-term follow-up. With regard to daytime sleepiness, initial administration of the drug caused an increase in objective sleepiness only in the control group. Subjective sleepiness was higher in the control group than in the TLE group but was not modified by the drug.

CONCLUSIONS

We conclude that CBZ-CR has negative effects on REM sleep during initial administration but chronic treatment does not significantly modify nocturnal sleep or daytime somnolence.

Ontogeny of feline temporal lobe epilepsy. III: Spontaneous sleep and arousal disorders in amygdala-kindled kittens

We report the ontogeny and persistence of sleep and arousal disorders in amygdala-kindled kittens. We also identify procedural differences that may explain discrepancies in the literature on postkindling sleep disorders. The study population consisted of 12 preadolescent kittens kindled between 2.5 and 6.5 months of age, 8 of which were followed to adulthood (> or = 1 year), and 8 unkindled implanted control animals. Sleep and seizure patterns were monitored on 12-24-h polygraphic or split-screen video recordings of EEG and behavioral activity. Kindled kittens displayed spontaneous seizure and interictal sleep anomalies that persisted to adulthood, as follows. As compared with neurosurgical controls, kindled kittens exhibited slow-wave sleep (SWS) and REM sleep insomnia at least 1 year after kindling and 1-5 months after convulsions, regardless of postictal recording delay. Sleep and arousal defects in kindled kittens were similar to but more pronounced than those in kindled adult cats, possibly because kittens spontaneously became epileptic. Detection of postkindling SWS insomnia could be masked by brief scoring epochs (less than the preferred 1-min epoch for cats); recurrent behavioral arousals after kindling frequently aborted 1-min SWS epochs but often did not interrupt 30-s SWS epochs (based on 1-min vs. 30-s minimum duration scoring criteria). Detection of postkindling REM sleep insomnia could be masked in kittens with alternating patterns of REM loss and REM rebound; all these kittens showed periodic bouts of REM onset from waking after kindling. Different data collection and analysis procedures influence detection of sleep and arousal disorders in amygdala-kindled cats when replication of findings is attempted. We conclude that these differences explain some controversies regarding the nature and prevalence of sleep disturbances in the kindling literature in temporal lobe epilepsy (TLE).

Transitory and short-duration changes of sleep organization provoked by amygdaloid kindling in the cat: a daily 23-hour sleep recording study

The effect of amygdaloid kindling on sleep organization was tested in chronically implanted cats on a 12:12 light-dark cycle. Electrical kindling stimuli were delivered to the amygdala every 2 h during the light period. Total sleep time and percentage, mean duration, and mean number, as well as the hourly accumulation of waking (W) and sleep (slow wave sleep I and II, and paradoxical sleep) episodes were assessed from daily 23-h sleep recordings, consisting of baseline control recordings, control recordings where cats were briefly alerted at 2-h intervals to mimic the kindling trials manipulation, and recordings on each kindling day. The kindling process was completed within six days achieving three to five consecutive fully kindled seizures. Analysis of total recording time showed that the kindling process enhanced W stage and diminished total sleep time only on the second kindling day. Analysis of light and dark periods demonstrated compensatory W and sleep changes during the dark periods. Hourly sleep stage time accumulation was slowed during kindling trials, but compensated while stimuli were suspended. All of these changes returned to baseline values at the end of kindling. No significant differences between changes induced by kindling and those produced by alerting trials were found. We conclude that sleep alterations can not be exclusively attributed to kindling development, and that sleep is able to become adapted to the focal and generalized seizures effect.

Effects of seizures and carbamazepine on interictal spiking in amygdala kindled cats

We examined the influence of seizures and carbamazepine (CBZ) on spiking rates in kindled cats. In the first experiment, spiking rates were measured before and after seizures, with and without CBZ. CBZ was administered immediately after seizures in order not to affect them. Spiking rates were measured over 9 h during the different sleep stages. In a second experiment, CBZ was administered before and after seizures so as to affect seizure strength and thus measure its effect on spiking. Results confirmed earlier findings of a large increase in spiking following a stage 6 seizure in fully kindled animals. We also established that: (1) repeated daily seizures caused a further increase in spiking until a ceiling was reached; (2) increased spiking was not a direct effect of postictal alterations in sleep stages; (3) CBZ, despite its effectiveness as an anticonvulsant, did not reduce spiking but rather increased it; (4) postictal increases in spiking were related to seizure 'strength'. These findings support the hypothesis that spiking rates are primarily influenced by seizure occurrence, as was found in patients with temporal lobe seizures, and that anticonvulsants act differently on seizures and spikes. This emphasizes the possibility of distinct pathophysiological mechanisms for interictal spikes and seizures.