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Chachua T, Chern CR, Velíšková J, Velíšek L. Epileptic spasms in infancy: Transferring rat prenatal betamethasone-postnatal NMDA model to mice. Neurosci Lett 2023; 813:137431. [PMID: 37591361 PMCID: PMC10529238 DOI: 10.1016/j.neulet.2023.137431] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/16/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
Epileptic spasms during infancy represent a devastating and refractory epilepsy syndrome. To advance studies on mechanisms and treatment using available mouse mutant models, we transferred our validated rat model of epileptic spasms to mice. Initially, we determined sensitivity of C57BL/6J mice to various doses (12-20 mg/kg) of NMDA on postnatal day 11 (P11) and P15. We primed mice with different doses of betamethasone (0.4-2.0 mg/kg) prenatally on gestational day (G)14 or G12 and tested spasms on P11. We also tested 2 different ACTH treatment paradigms (0.3 or 1.0 mg/kg) in prenatally primed as well as naïve mice. Data show that spasms in P11 mice, can be induced with the highest yield after 12 mg/kg dose of NMDA. Prenatal priming on G14 did not modify response to NMDA or sensitize spasms to ACTH. The betamethasone priming on G12 resulted in an increase in the number of NMDA-triggered spasms. Data indicate that the model transfer from rats to mice is non-linear and differences in prenatal brain development, metabolic rates, as well as sensitivity to convulsant drugs have to be considered.
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Affiliation(s)
- Tamar Chachua
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA
| | - Chian-Ru Chern
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA
| | - Jana Velíšková
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA; Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA; Department of Neurology, New York Medical College, Valhalla, NY, USA
| | - Libor Velíšek
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA; Department of Neurology, New York Medical College, Valhalla, NY, USA; Department of Pediatrics, New York Medical College, Valhalla, NY, USA.
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Chern CR, Lauková M, Schonwald A, Kudová E, Chodounská H, Chern CJ, Shakarjian MP, Velíšková J, Velíšek L. Novel neurosteroid pregnanolone pyroglutamate suppresses neurotoxicity syndrome induced by tetramethylenedisulfotetramine but is ineffective in a rodent model of infantile spasms. Pharmacol Rep 2023; 75:177-188. [PMID: 36422805 PMCID: PMC10785007 DOI: 10.1007/s43440-022-00437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/14/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neurosteroids are investigated as effective antidotes for the poisoning induced by tetramethylenedisulfotetramine (TMDT) as well as treatments for epileptic spasms during infancy. Both these conditions are quite resistant to pharmacotherapy; thus, a search for new treatments is warranted. METHODS In this study, we determined the efficacy of two novel neurosteroids, pregnanolone glutamate (PAG) and pregnanolone pyroglutamate (PPG), and tested these drugs in doses of 1-10 mg/kg (ip) against the TMDT syndrome and in our rodent model of infantile spasms. RESULTS Only PPG in doses 5 and 10 mg/kg suppressed the severity of the TMDT syndrome and TMDT-induced lethality, while the 1 mg/kg dose was without an effect. Interestingly, the 1 mg/kg dose of PPG in combination with 1 mg/kg of diazepam was also effective against TMDT poisoning. Neither PAG nor PPG were effective against experimental spasms in the N-methyl-D-aspartate (NMDA)-triggered model of infantile spasms. CONCLUSIONS While evidence suggests that PAG can act through multiple actions which include allosteric inhibition of NMDA-induced and glycine receptor-evoked currents as well as augmentation of ɣ-aminobutyric acid subtype A (GABAA) receptor-induced currents, the agent appears to neither have the appropriate mechanistic signature for activity in the infantile spasm model, nor the adequate potency, relative to PPG, for ameliorating the TMDT syndrome. The full mechanisms of action of PPG, which may become a potent TMDT antidote either alone or in combination with diazepam are yet unknown and thus require further investigation.
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Affiliation(s)
- Chian-Ru Chern
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA
| | - Marcela Lauková
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA
- Institute of Experimental Endocrinology, Biomedical Research Center of the Slovak Academy of Science, Bratislava, Slovakia
| | - Antonia Schonwald
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA
| | - Eva Kudová
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Hana Chodounská
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Chian-Jiang Chern
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA
| | - Michael P Shakarjian
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA
- Department of Public Health, Environmental Health Science Program, New York Medical College, Valhalla, NY, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rutgers-Robert Wood Johnson Medical School, 675 Hoes Ln W, Piscataway, NJ, 08854, USA
| | - Jana Velíšková
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, NY, USA
- Department of Neurology, New York Medical College, Valhalla, NY, USA
| | - Libor Velíšek
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, NY, USA.
- Department of Neurology, New York Medical College, Valhalla, NY, USA.
- Department of Pediatrics, New York Medical College, Valhalla, NY, USA.
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Velíšek L, Velíšková J. Modeling epileptic spasms during infancy: Are we heading for the treatment yet? Pharmacol Ther 2020; 212:107578. [PMID: 32417271 PMCID: PMC7299814 DOI: 10.1016/j.pharmthera.2020.107578] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 05/07/2020] [Indexed: 12/22/2022]
Abstract
Infantile spasms (IS or epileptic spasms during infancy) were first described by Dr. William James West (aka West syndrome) in his own son in 1841. While rare by definition (occurring in 1 per 3200-3400 live births), IS represent a major social and treatment burden. The etiology of IS varies - there are many (>200) different known pathologies resulting in IS and still in about one third of cases there is no obvious reason. With the advancement of genetic analysis, role of certain genes (such as ARX or CDKL5 and others) in IS appears to be important. Current treatment strategies with incomplete efficacy and serious potential adverse effects include adrenocorticotropin (ACTH), corticosteroids (prednisone, prednisolone) and vigabatrin, more recently also a combination of hormones and vigabatrin. Second line treatments include pyridoxine (vitamin B6) and ketogenic diet. Additional treatment approaches use rapamycin, cannabidiol, valproic acid and other anti-seizure medications. Efficacy of these second line medications is variable but usually inferior to hormonal treatments and vigabatrin. Thus, new and effective models of this devastating condition are required for the search of additional treatment options as well as for better understanding the mechanisms of IS. Currently, eight models of IS are reviewed along with the ideas and mechanisms behind these models, drugs tested using the models and their efficacy and usefulness. Etiological variety of IS is somewhat reflected in the variety of the models. However, it seems that for finding precise personalized approaches, this variety is necessary as there is no "one-size-fits-all" approach possible for both IS in particular and epilepsy in general.
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Affiliation(s)
- Libor Velíšek
- Departments of Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA; Departments of Pediatrics, New York Medical College, Valhalla, NY, USA; Departments of Neurology, New York Medical College, Valhalla, NY, USA.
| | - Jana Velíšková
- Departments of Cell Biology & Anatomy, New York Medical College, Valhalla, NY, USA; Departments of Neurology, New York Medical College, Valhalla, NY, USA; Departments of Obstetrics & Gynecology, New York Medical College, Valhalla, NY, USA
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Chern CR, Chern CJ, Velíšková J, Velíšek L. ACTON PROLONGATUM® suppresses spasms head to head with Acthar® Gel in the model of infantile spasms. Epilepsy Behav 2020; 105:106950. [PMID: 32092460 DOI: 10.1016/j.yebeh.2020.106950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/17/2020] [Accepted: 01/26/2020] [Indexed: 12/18/2022]
Abstract
Epileptic spasms during infancy (infantile spasms, IS) are a rare epilepsy syndrome with dire prognosis. Current treatments, effective in about 55% of cases, include hormonal therapy (adrenocorticotropic hormone [ACTH] = adrenocorticotropin or corticosteroids) or vigabatrin (also in combination with hormones). In addition to their limited efficacy, these treatments may also carry serious adverse effects. Thus, the search for new effective drugs to treat this rare disease is desirable. In this study, we determined the efficacy of ACTON PROLONGATUM® (AP; Ferring Pharmaceuticals) in comparison with Acthar® Gel (Mallinckrodt) and full 39 amino-acid rat ACTH molecule (Genscript) in the rodent model of IS consisting of prenatal priming with betamethasone and repeated postnatal trigger of spasms with N-methyl-d-aspartate. Treatment with these ACTH varieties was given on postnatal days (P)12, P13, and P14 in a prospective test (treatment onset on P12 AFTER induction of spasms). Two independent arms were investigated: subcutaneous (SC) and intramuscular (IM) deliveries that were evaluated separately. In the SC arm, there was a significant suppression of the number of spasms after both Acthar® Gel and AP on P13 and P15 compared with gelatin control. In the IM arm, a significant suppression of the number of spasms was achieved only after AP on both P13 and P15 indicating that after IM delivery, Acthar® Gel was not as effective as AP. In this study, we confirmed the efficacy of two ACTH formulations (gelatin-based Acthar® Gel and carboxymethyl cellulose-based AP) in the model of IS. ACTON PROLONGATUM® may become a valuable therapy for IS. In our animal model, AP was at least as efficient as the standard of care, Acthar® Gel.
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Affiliation(s)
- Chian-Ru Chern
- Department of Cell Biology & Anatomy, New York Medical College, School of Medicine, Valhalla, NY 10595, USA
| | - Chian-Jiang Chern
- Department of Cell Biology & Anatomy, New York Medical College, School of Medicine, Valhalla, NY 10595, USA
| | - Jana Velíšková
- Department of Cell Biology & Anatomy, New York Medical College, School of Medicine, Valhalla, NY 10595, USA; Department of Obstetrics & Gynecology, New York Medical College, School of Medicine, Valhalla, NY 10595, USA; Department of Neurology, New York Medical College, School of Medicine, Valhalla, NY 10595, USA
| | - Libor Velíšek
- Department of Cell Biology & Anatomy, New York Medical College, School of Medicine, Valhalla, NY 10595, USA; Department of Neurology, New York Medical College, School of Medicine, Valhalla, NY 10595, USA; Department of Pediatrics, New York Medical College, School of Medicine, Valhalla, NY 10595, USA.
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Auvin S, Dozières-Puyravel B, Avbersek A, Sciberras D, Collier J, Leclercq K, Mares P, Kaminski RM, Muglia P. Radiprodil, a NR2B negative allosteric modulator, from bench to bedside in infantile spasm syndrome. Ann Clin Transl Neurol 2020; 7:343-352. [PMID: 32106360 PMCID: PMC7085998 DOI: 10.1002/acn3.50998] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Infantile spasm syndrome (ISS) is an epileptic encephalopathy without established treatment after the failure to standard of care based on steroids and vigabatrin. Converging lines of evidence indicating a role of NR2B subunits of the N‐methyl‐D‐aspartate (NMDA) receptor on the onset of spams in ISS patients, prompted us to test radiprodil, a negative allosteric NR2B modulator in preclinical seizure models and in infants with ISS. Methods Radiprodil has been tested in three models, including pentylenetetrazole‐induced seizures in rats across different postnatal (PN) ages. Three infants with ISS have been included in a phase 1b escalating repeated dose study. Results Radiprodil showed the largest protective seizure effects in juvenile rats (maximum at PN12, corresponding to late infancy in humans). Three infants resistant to a combination of vigabatrin and prednisolone received individually titrated doses of radiprodil for up to 34 days. Radiprodil was safe and well tolerated in all three infants, and showed the expected pharmacokinetic profile. One infant became spasm‐free and two showed clinical improvement without reaching spasm‐freedom. After radiprodil withdrawal, the one infant continued to be spasm‐free, while the two others experienced seizure worsening requiring the use of the ketogenic diet and other antiepileptic drugs. Interpretation Radiprodil showed prominent anti‐seizure effect in juvenile animals, consistent with the prevalent expression of NR2B subunit of the NMDA receptor at this age in both rodents and humans. The clinical testing, although preliminary, showed that radiprodil is associated with a good safety and pharmacokinetic profile, and with the potential to control epileptic spasms.
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Affiliation(s)
- Stéphane Auvin
- Service de Neurologie Pédiatrique, Hôpital Robert Debré, Paris, France.,Université de Paris, INSERM U1141, F-75019, Paris, France
| | - Blandine Dozières-Puyravel
- Service de Neurologie Pédiatrique, Hôpital Robert Debré, Paris, France.,Université de Paris, INSERM U1141, F-75019, Paris, France
| | | | | | | | | | - Pavel Mares
- Institute of Physiology, The Czech Academy of Sciences, Prague, Czech Republic
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Benson MJ, Lauková M, Borges K, Velíšková J, Velíšek L. Prenatal betamethasone exposure increases corticotropin-releasing hormone expression along with increased hippocampal slice excitability in the developing hippocampus. Epilepsy Res 2020; 160:106276. [PMID: 31954921 DOI: 10.1016/j.eplepsyres.2020.106276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/31/2019] [Accepted: 01/14/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND The objective of this study was to determine whether prenatal exposure to betamethasone alters hippocampal expression of corticotropin-releasing hormone (CRH) and resultant hippocampal circuit excitability. METHODS Real time (RT)-PCR and western blots were used to determine CRH mRNA and protein expression levels, respectively, in hippocampal extracts of two-week old rat pups prenatally primed with betamethasone or saline on gestational day 15. The data were compared to changes in epileptiform activity induced by kainic acid (KA) or depletion of [Mg2+]0 in combined hippocampus-entorhinal cortex slices. RESULTS RT-PCR analysis showed 3-fold increased levels of CRH mRNA in hippocampal extracts from prenatally betamethasone-primed pups compared to saline controls (p < 0.05), but no changes in mRNA expression of CRH receptors (1 and 2). Changes in CRH protein isoform ratio in hippocampal extracts suggest 30 % increase in mature CRH levels in betamethasone-primed hippocampi (p < 0.05). No changes in mRNA expression in CRH feedback loop associated genes, GR and FKBP51, were found. Compared to saline-exposed pups, slices from betamethasone-primed pups had faster onset of epileptiform-like activity (inter-ictal discharges and seizure-like-events) after bath application of 4 μM KA (p < 0.05) suggesting a "more hyperexcitable" state. The epileptiform-like activity after KA application was significantly reduced following bath application of a CRH R2 antagonist (p < 0.05) but CRH R1 antagonist had no effect (p > 0.05). Also in the low-Mg2+-induced epileptiform activity, there was increased excitability, in the form of enhanced inter-ictal discharges, in slices from betamethasone primed compared to saline exposed rat pups (p < 0.05). CONCLUSIONS Our study suggests a possible mechanistic link to prenatal betamethasone priming-induced increase in postnatal hippocampal excitability that involves enhanced expression of CRH acting at CRH R2. This is important in regards to the links between prenatal stress/corticosteroid-exposure and syndromes, such as epilepsy, autism spectrum disorders and other psychiatric disorders associated with neuronal hyperexcitability.
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Affiliation(s)
- Melissa J Benson
- Departments of Cell Biology & Anatomy, Valhalla, NY, USA; Department of Pharmacology, School of Biomedical Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Marcela Lauková
- Department of Environmental Health Science, School of Health Sciences and Practice, Institute of Public Health, New York Medical College, Valhalla, NY, USA; Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Karin Borges
- Department of Pharmacology, School of Biomedical Sciences, University of Queensland, St Lucia, QLD, Australia
| | - Jana Velíšková
- Departments of Cell Biology & Anatomy, Valhalla, NY, USA; Departments of Obstetrics & Gynecology, Valhalla, NY, USA; Departments of Neurology, Valhalla, NY, USA
| | - Libor Velíšek
- Departments of Cell Biology & Anatomy, Valhalla, NY, USA; Departments of Obstetrics & Gynecology, Valhalla, NY, USA; Departments of Pediatrics, New York Medical College, Valhalla, NY, USA.
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Infantile Spasms: An Update on Pre-Clinical Models and EEG Mechanisms. CHILDREN-BASEL 2020; 7:children7010005. [PMID: 31935804 PMCID: PMC7023485 DOI: 10.3390/children7010005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/06/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022]
Abstract
Infantile spasms (IS) is an epileptic encephalopathy with unique clinical and electrographic features, which affects children in the middle of the first year of life. The pathophysiology of IS remains incompletely understood, despite the heterogeneity of IS etiologies, more than 200 of which are known. In particular, the neurobiological basis of why multiple etiologies converge to a relatively similar clinical presentation has defied explanation. Treatment options for this form of epilepsy, which has been described as “catastrophic” because of the poor cognitive, developmental, and epileptic prognosis, are limited and not fully effective. Until the pathophysiology of IS is better clarified, novel treatments will not be forthcoming, and preclinical (animal) models are essential for advancing this knowledge. Here, we review preclinical IS models, update information regarding already existing models, describe some novel models, and discuss exciting new data that promises to advance understanding of the cellular mechanisms underlying the specific EEG changes seen in IS—interictal hypsarrhythmia and ictal electrodecrement.
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Lee M, Kim MJ, Kim EJ, Woo DC, Yum MS, Ko TS. How can methylprednisolone work on epileptic spasms with malformation of cortical development? Eur J Neurosci 2019; 50:4018-4027. [PMID: 31397941 DOI: 10.1111/ejn.14539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/04/2019] [Accepted: 07/25/2019] [Indexed: 12/15/2022]
Abstract
Although steroids are suggested as the treatment of choice for infantile spasms, the mechanism of action is still unclear. Using a rat model of malformation of cortical development with refractory infantile spasms, we evaluated the efficacy of methylprednisolone on spasms susceptibility and behaviors. Additionally, we investigated the in vivo electrophysiological and neurochemical changes of the brain after methylprednisolone treatment. Infant rats with prenatal exposure of methylazoxymethanol at gestational day 15 were used. After a single dose of methylprednisolone or three different doses of methylprednisolone for 3 days, spasms were triggered by intraperitoneal injection of N-methyl-d-aspartic acid. In rats with 3 days of methylprednisolone pretreatment and their controls, behavioral testing was performed at postnatal day 15. In vivo magnetic resonance imaging was conducted at postnatal day 15 after 3 days of methylprednisolone treatment. The rats with single methylprednisolone pretreatment showed significantly delayed onset of spasms and multiple doses of methylprednisolone significantly suppressed the development of spasms in a dose-dependent manner. After multiple methylprednisolone pretreatment and a cluster of N-methyl-d-aspartic acid-induced spasms, the rats showed significantly increased freezing behaviors to conditioned stimuli. Glutamate-weighted chemical exchange saturation transfer revealed significant elevation of glutamate concentration in the cortices of the rats with multiple methylprednisolone pretreatments. Methylprednisolone pretreatment could attenuate N-methyl-d-aspartic acid-induced spasms with in vivo neurochemical and electrophysiological changes, which indicates this steroid's action on the brain and in epilepsy.
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Affiliation(s)
- Minyoung Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea
| | - Min-Jee Kim
- Department of Pediatrics, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Eun-Jin Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea
| | - Dong-Cheol Woo
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea
| | - Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea
| | - Tae-Sung Ko
- Department of Pediatrics, Asan Medical Center Children's Hospital, Ulsan University College of Medicine, Seoul, Korea
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Chern CR, Chern CJ, Velíšková J, Velíšek L. AQB-565 shows promise in preclinical testing in the model of epileptic spasms during infancy: Head-to-head comparison with ACTH. Epilepsy Res 2019; 152:31-34. [PMID: 30875634 DOI: 10.1016/j.eplepsyres.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/18/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
Epileptic spasms during infancy (infantile spasms) represent a serious treatment and social problem despite their rare occurrence. Current treatments include hormonal therapy (adrenocorticotropin-ACTH or corticosteroids) or vigabatrin (per se or in the combination). These treatments are partially effective and with potentially significant adverse effects. Thus, the search for new effective drugs is warranted. We tested efficacy of a novel fusion peptide AQB-565 developed by Aequus Biopharma in a model of infantile spasms consisting of prenatal exposure to betamethasone and repeated postnatal trigger of spasms with N-methyl-d-aspartic acid (NMDA). AQB-565 molecule includes the first 24 amino acids of ACTH, a ten amino acid linker and a modified melanocyte-stimulating hormone molecule. In contrast to ACTH with almost uniform activity over all peripheral and central melanocortin receptor isoforms, AQB is preferentially active on central melanocortin receptors MC3 and MC4. Here, we used equivalent doses of rat ACTH (full molecule) and AQB-565 and compared their efficacy in a prospective randomized test against of repeated bouts of spasms on postnatal days (P)12, P13 and P15 in the rat model. All doses of ACTH (range 0.02-1.0 mg/kg s.c.) and all doses but one of AQB-565 in the same range suppressed spasms in P15 rats (treatment stopped on P14). There was no dose-dependent effect and both compounds had all-or-none effect that is similar to clinical outcome of hormonal treatment of infantile spasms in children. Thus, AQB-565 may represent a novel treatment of infantile spasms similarly effective as ACTH but with potentially limited side effects.
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Affiliation(s)
- Chian-Ru Chern
- Department of Cell Biology & Anatomy, New York Medical College School of Medicine, Valhalla, NY, 10595, USA
| | - Chian-Jiang Chern
- Department of Cell Biology & Anatomy, New York Medical College School of Medicine, Valhalla, NY, 10595, USA
| | - Jana Velíšková
- Department of Cell Biology & Anatomy, New York Medical College School of Medicine, Valhalla, NY, 10595, USA; Department of Obstetrics & Gynecology, New York Medical College School of Medicine, Valhalla, NY, 10595, USA; Department of Neurology, New York Medical College School of Medicine, Valhalla, NY, 10595, USA
| | - Libor Velíšek
- Department of Cell Biology & Anatomy, New York Medical College School of Medicine, Valhalla, NY, 10595, USA; Department of Neurology, New York Medical College School of Medicine, Valhalla, NY, 10595, USA; Department of Pediatrics, New York Medical College School of Medicine, Valhalla, NY, 10595, USA.
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10
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Huizenga MN, Sepulveda-Rodriguez A, Forcelli PA. Preclinical safety and efficacy of cannabidivarin for early life seizures. Neuropharmacology 2019; 148:189-198. [PMID: 30633929 DOI: 10.1016/j.neuropharm.2019.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/26/2018] [Accepted: 01/02/2019] [Indexed: 01/25/2023]
Abstract
A significant proportion of neonatal and childhood seizures are poorly controlled by existing anti-seizure drugs (ASDs), likely due to prominent differences in ionic homeostasis and network connectivity between the immature and mature brain. In addition to the poor efficacy of current ASDs, many induce apoptosis, impair synaptic development, and produce behavioral deficits when given during early postnatal development. There is growing interest in new targets, such as cannabidiol (CBD) and its propyl analog cannabidivarin (CBDV) for early life indications. While CBD was recently approved for treatment of refractory childhood epilepsies, little is known about the efficacy or safety of CBDV. Here, we addressed this gap through a systematic evaluation of CBDV against multiple seizure models in postnatal day (P) 10 and 20 animals. We also evaluated the impact of CBDV on acute neurotoxicity in immature rats. CBDV (50-200 mg/kg) displayed an age and model-specific profile of anticonvulsant action. In P10 rats, CBDV suppressed seizures only in the pentylenetetrazole model. In P20 rats, CBDV suppressed seizures in the pentylenetetrazole, DMCM, and maximal electroshock models. Between P10 and P20, we identified significant increases in mRNA expression of TRPV1 in multiple brain regions; when CBDV was tested in P20 TRPV1 knockout mice, anticonvulsant effects were attenuated. Finally, CBDV treatment generally avoided induction of neuronal degeneration in immature rats. Together, the efficacy and safety profile of CBDV suggest it may have therapeutic value for early life seizures.
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Affiliation(s)
- Megan N Huizenga
- Department of Pharmacology and Physiology, Georgetown University, Washington, DC, United States
| | - Alberto Sepulveda-Rodriguez
- Department of Pharmacology and Physiology, Georgetown University, Washington, DC, United States; Interdisciplinary Program in Neuroscience, Georgetown University, Washington, DC, United States
| | - Patrick A Forcelli
- Department of Pharmacology and Physiology, Georgetown University, Washington, DC, United States; Department of Neuroscience, Georgetown University, Washington, DC, United States; Interdisciplinary Program in Neuroscience, Georgetown University, Washington, DC, United States.
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11
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Lauková M, Velíšková J, Velíšek L, Shakarjian MP. Developmental and sex differences in tetramethylenedisulfotetramine (TMDT)-induced syndrome in rats. Dev Neurobiol 2018; 78:403-416. [PMID: 29411537 DOI: 10.1002/dneu.22582] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 01/15/2018] [Accepted: 02/01/2018] [Indexed: 12/21/2022]
Abstract
Tetramethylenedisulfotetramine (TMDT) is a synthetic neurotoxic rodenticide considered a chemical threat agent. Symptoms of intoxication include seizures leading to status epilepticus and death. While children and women have been often the victims, no studies exist investigating the neurotoxic effects of TMDT in developing individuals or females. Thus, we performed such an investigation in developing Sprague-Dawley rats of both sexes in order to identify potential age- or sex-dependent vulnerability to TMDT exposure. Subcutaneous injection was chosen as the preferred route of TMDT exposure. EEG recordings confirmed the seizure activity observed in both postnatal day 15 (P15) and adult rats. Additionally, P15 rats displayed greater sensitivity to TMDT than postnanatal day 25 or adult animals. Seizures were generally more severe in females compared to males. Barrel rotations accompanied convulsions in P25 and adult, but sparsely in P15 rats. Adults developed barrel rolling less frequently than P25 population. Neuronal cell death was not present in 24-h TMDT survivors at any age or sex tested. A seizure rechallenge with flurothyl 7 days following TMDT exposure demonstrated longer latencies to the first clonic seizure but a faster progression into the tonic-clonic seizure in P15 and adult survivors as compared to their vehicle-injected counterparts. In conclusion, the youngest age group represents the most vulnerable population to the TMDT-induced toxidrome. Females appear to be more vulnerable than males. TMDT exposure promotes seizure spread and progression in survivors. These findings will help to establish sex- and age-specific treatment strategies for TMDT-exposed individuals. © 2018 Wiley Periodicals, Inc. Develop Neurobiol 78: 403-416, 2018.
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Affiliation(s)
- Marcela Lauková
- Department of Public Health, Division of Environmental Health Science, School of Health Sciences and Practice, New York Medical College, Valhalla, New York.,Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jana Velíšková
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York.,Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York.,Department of Neurology, New York Medical College, Valhalla, New York
| | - Libor Velíšek
- Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York.,Department of Neurology, New York Medical College, Valhalla, New York.,Department of Pediatrics, New York Medical College, Valhalla, New York
| | - Michael P Shakarjian
- Department of Public Health, Division of Environmental Health Science, School of Health Sciences and Practice, New York Medical College, Valhalla, New York.,Department of Cell Biology and Anatomy, New York Medical College, Valhalla, New York.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey
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12
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Kim EH, Yum MS, Lee M, Kim EJ, Shim WH, Ko TS. A New Rat Model of Epileptic Spasms Based on Methylazoxymethanol-Induced Malformations of Cortical Development. Front Neurol 2017; 8:271. [PMID: 28659857 PMCID: PMC5466970 DOI: 10.3389/fneur.2017.00271] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 05/26/2017] [Indexed: 02/03/2023] Open
Abstract
Malformations of cortical development (MCDs) can cause medically intractable epilepsies and cognitive disabilities in children. We developed a new model of MCD-associated epileptic spasms by treating rats prenatally with methylazoxymethanol acetate (MAM) to induce cortical malformations and postnatally with N-methyl-d-aspartate (NMDA) to induce spasms. To produce cortical malformations to infant rats, two dosages of MAM (15 mg/kg, intraperitoneally) were injected to pregnant rats at gestational day 15. In prenatally MAM-exposed rats and the controls, spasms were triggered by single (6 mg/kg on postnatal day 12 (P12) or 10 mg/kg on P13 or 15 mg/kg on P15) or multiple doses (P12, P13, and P15) of NMDA. In prenatally MAM-exposed rats with single NMDA-provoked spasms at P15, we obtain the intracranial electroencephalography and examine the pretreatment response to adrenocorticotropic hormone (ACTH) or vigabatrin. Rat pups prenatally exposed to MAM exhibited a significantly greater number of spasms in response to single and multiple postnatal NMDA doses than vehicle-exposed controls. Vigabatrin treatment prior to a single NMDA dose on P15 significantly suppressed spasms in MAM group rats (p < 0.05), while ACTH did not. The MAM group also showed significantly higher fast oscillation (25–100 Hz) power during NMDA-induced spasms than controls (p = 0.047). This new model of MCD-based epileptic spasms with corresponding features of human spasms will be valuable for future research of the developmental epilepsy.
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Affiliation(s)
- Eun-Hee Kim
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, South Korea
| | - Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Minyoung Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Jin Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo-Hyun Shim
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Tae-Sung Ko
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
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13
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Pirone A, Alexander J, Lau LA, Hampton D, Zayachkivsky A, Yee A, Yee A, Jacob MH, Dulla CG. APC conditional knock-out mouse is a model of infantile spasms with elevated neuronal β-catenin levels, neonatal spasms, and chronic seizures. Neurobiol Dis 2016; 98:149-157. [PMID: 27852007 DOI: 10.1016/j.nbd.2016.11.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 10/24/2016] [Accepted: 11/11/2016] [Indexed: 01/08/2023] Open
Abstract
Infantile spasms (IS) are a catastrophic childhood epilepsy syndrome characterized by flexion-extension spasms during infancy that progress to chronic seizures and cognitive deficits in later life. The molecular causes of IS are poorly defined. Genetic screens of individuals with IS have identified multiple risk genes, several of which are predicted to alter β-catenin pathways. However, evidence linking malfunction of β-catenin pathways and IS is lacking. Here, we show that conditional deletion in mice of the adenomatous polyposis coli gene (APC cKO), the major negative regulator of β-catenin, leads to excessive β-catenin levels and multiple salient features of human IS. Compared with wild-type littermates, neonatal APC cKO mice exhibit flexion-extension motor spasms and abnormal high-amplitude electroencephalographic discharges. Additionally, the frequency of excitatory postsynaptic currents is increased in layer V pyramidal cells, the major output neurons of the cerebral cortex. At adult ages, APC cKOs display spontaneous electroclinical seizures. These data provide the first evidence that malfunctions of APC/β-catenin pathways cause pathophysiological changes consistent with IS. Our findings demonstrate that the APC cKO is a new genetic model of IS, provide novel insights into molecular and functional alterations that can lead to IS, and suggest novel targets for therapeutic intervention.
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Affiliation(s)
- Antonella Pirone
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, United States
| | - Jonathan Alexander
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, United States; Neuroscience Program, Tufts Sackler School of Biomedical Sciences, Boston, MA 02111, United States
| | - Lauren A Lau
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, United States; Neuroscience Program, Tufts Sackler School of Biomedical Sciences, Boston, MA 02111, United States
| | - David Hampton
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, United States
| | - Andrew Zayachkivsky
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Amy Yee
- Department of Developmental, Molecular, and Chemical Biology, Tufts University School of Medicine, Boston, MA 02111, United States
| | - Audrey Yee
- VA Eastern Colorado Health System, Golden, CO 80401, United States
| | - Michele H Jacob
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, United States.
| | - Chris G Dulla
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA 02111, United States.
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14
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Baek H, Yi MH, Pandit S, Park JB, Kwon HH, Zhang E, Kim S, Shin N, Kim E, Lee YH, Kim Y, Kim DW, Kang JW. Altered expression of KCC2 in GABAergic interneuron contributes prenatal stress-induced epileptic spasms in infant rat. Neurochem Int 2016; 97:57-64. [PMID: 27180051 DOI: 10.1016/j.neuint.2016.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 04/25/2016] [Accepted: 05/10/2016] [Indexed: 02/06/2023]
Abstract
Long-term stress during pregnancy causes neurologic deficits to offspring with altered gamma-aminobutyric acid (GABA) system in the brain. However, it is not clear how prenatal stress affects the maturing GABAergic interneurons and the resulting abnormalities in infantile seizures. Here, we showed that prenatal stress alters the maturation of GABA inhibitory system using a seizure model induced by prenatal stress. Prenatal stress with betamethasone or acute immobilization stress (AIS) on gestational day 15 increased the seizure susceptibility to N-methyl-d-aspartate-triggered spasms on postnatal day 15. The expression of GABA was lower in the prenatally stressed group, which compromise the decrease of glutamate decarboxylase 67-immunopositive cells. Prenatal stress markedly decreased the expression of K(+)/Cl(-) co-transporter (KCC2) in the cortex. GABA induced membrane depolarization demonstrated prenatal stress models had significant higher membrane depolarization compared to control. GABA increased KCC2 expression in cultured cortex-containing slices. Taken together, our results showed that prenatal stress with betamethasone or AIS altered the maturation of GABAergic progenitors and resulted in the lack of GABA input, which in turn, decreased KCC2 expression and lowered seizure threshold. We conclude that delayed GABA excitatory/inhibitory shift would render the cortical neuronal circuit more susceptible to excitatory input in prenatal stress induced seizure.
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Affiliation(s)
- Hyunjung Baek
- Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea; Department of Pediatrics, Chungnam National University Hospital, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 282, Jung-gu, Daejeon, 301-721, Republic of Korea
| | - Min-Hee Yi
- Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea
| | - Sudip Pandit
- Department of Physiology, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea
| | - Jin Bong Park
- Department of Physiology, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea
| | - Hyeok Hee Kwon
- Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea; Department of Pediatrics, Chungnam National University Hospital, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 282, Jung-gu, Daejeon, 301-721, Republic of Korea
| | - Enji Zhang
- Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea
| | - Sena Kim
- Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea; Department of Plastic Surgery, Chungnam National University Hospital, Munwha-ro 282, Jung-gu, Daejeon, 301-721, Republic of Korea
| | - Nara Shin
- Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea; Anesthesia and Pain Medicine, Chungnam National University Hospital, Munwha-ro 282, Jung-gu, Daejeon, 301-721, Republic of Korea
| | - Eunjee Kim
- Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea
| | - Young Ho Lee
- Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea
| | - Yonghyun Kim
- Department of Chemical and Biological Engineering, The University of Alabama, Tuscaloosa, AL 35487, USA
| | - Dong Woon Kim
- Department of Anatomy, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 266, Jung-gu, Daejeon, 301-747, Republic of Korea.
| | - Joon Won Kang
- Department of Pediatrics, Chungnam National University Hospital, Brain Research Institute, Chungnam National University School of Medicine, Munwha-ro 282, Jung-gu, Daejeon, 301-721, Republic of Korea.
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15
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Shao LR, Stafstrom CE. Pediatric Epileptic Encephalopathies: Pathophysiology and Animal Models. Semin Pediatr Neurol 2016; 23:98-107. [PMID: 27544466 DOI: 10.1016/j.spen.2016.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Epileptic encephalopathies are syndromes in which seizures or interictal epileptiform activity contribute to or exacerbate brain function, beyond that caused by the underlying pathology. These severe epilepsies begin early in life, are associated with poor lifelong outcome, and are resistant to most treatments. Therefore, they represent an immense challenge for families and the medical care system. Furthermore, the pathogenic mechanisms underlying the epileptic encephalopathies are poorly understood, hampering attempts to devise novel treatments. This article reviews animal models of the three classic epileptic encephalopathies-West syndrome (infantile spasms), Lennox-Gastaut syndrome, and continuous spike waves during sleep or Landau-Kleffner syndrome-with discussion of how animal models are revealing underlying pathophysiological mechanisms that might be amenable to targeted therapy.
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Affiliation(s)
- Li-Rong Shao
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Carl E Stafstrom
- Division of Pediatric Neurology, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD.
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16
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Tsuji M, Takahashi Y, Watabe AM, Kato F. Enhanced long-term potentiation in mature rats in a model of epileptic spasms with betamethasone-priming and postnatal N-methyl-D-aspartate administration. Epilepsia 2016; 57:495-505. [PMID: 26792416 DOI: 10.1111/epi.13315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Patients with epileptic spasms are at high risk for learning and memory impairment later in life. We examined whether synaptic plasticity is affected in the adult hippocampus, a structure responsible for learning and memory, using an animal model of epileptic spasms of unknown cause. METHODS We produced a rat model of N-methyl-d-aspartate (NMDA)-induced spasms combined with prenatal betamethasone administration. In 6- to 11-week-old rats, we evaluated the long-term potentiation (LTP) and general properties of synaptic transmission in pyramidal neurons in the CA1 area of the hippocampus in brain slices. RESULTS The magnitude of LTP by theta burst stimulation was significantly larger in adult rats with a history of infantile NMDA injections than in control rats and rats that received additional adrenocorticotropic hormone (ACTH) treatment. The frequency of spontaneous excitatory transmission, but not inhibitory transmission, was smaller in adult rats with a history of infantile NMDA injections. SIGNIFICANCE This study is the first to provide a basis for the alteration of synaptic plasticity and transmission in a model of epileptic spasms of unknown cause. Postnatal NMDA treatment causing epileptic spasms-like aberrant episodes in the early stage of life in rats has a latent influence on various forms of synaptic plasticity in the hippocampus. Our results provide a novel insight into cognitive impairment that appears later in life in patients with a history of epileptic spasms.
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Affiliation(s)
- Megumi Tsuji
- Department of Neuroscience, The Jikei University School of Medicine, Tokyo, Japan.,Division of Pediatric Neurology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yukari Takahashi
- Department of Neuroscience, The Jikei University School of Medicine, Tokyo, Japan
| | - Ayako M Watabe
- Department of Neuroscience, The Jikei University School of Medicine, Tokyo, Japan.,Precursory Research for Embryonic Science and Technology (PRESTO), Japan Science and Technology Agency, Kawaguchi, Saitama, Japan
| | - Fusao Kato
- Department of Neuroscience, The Jikei University School of Medicine, Tokyo, Japan
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17
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Yum MS, Lee M, Woo DC, Kim DW, Ko TS, Velíšek L. β-Hydroxybutyrate attenuates NMDA-induced spasms in rats with evidence of neuronal stabilization on MR spectroscopy. Epilepsy Res 2015; 117:125-32. [PMID: 26452206 DOI: 10.1016/j.eplepsyres.2015.08.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/15/2015] [Accepted: 08/06/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Infantile spasms (IS) is a devastating epileptic encephalopathy. The ketogenic diet (KD) has been successfully used as a treatment for IS. This study was designed to test whether beta-hydroxybutyrate (BHB), a major metabolite of the KD, is effective in an animal model of IS. METHODS Pregnant rats received betamethasone on gestational day 15. The offspring received either single [30min prior to NMDA-triggered spasms on postnatal day (P) 15] or prolonged (three per day from P12 to P15) i.p. BHB. An additional experiment used repeated bouts of spasms on P12, P13, and P15 with randomized prolonged BHB treatment initiated after the first spasms. We determined the latency to onset of spasms and the number of spasms after the NMDA injection on P15. The rats that received randomized BHB treatment were also monitored with open field, sociability, and fear-conditioning tests and underwent in vivo (1)H MR imaging on a 9.4T MR system after NMDA-induced spasms. The acquired (1)H MR spectra were quantified using LC model. RESULTS Single-dose BHB pretreatment had no effect on spasms. In contrast, prolonged pretreatment with BHB significantly delayed the onset and decreased the frequency of spasms. In addition, randomized prolonged BHB treatment resulted in a significant reduction in number of spasms at P15. BHB treatment had no significant effect on motor activities, but significantly decreased the interactions with strangers and increased the contextual memory. On MR spectroscopic analysis of randomized prolonged BHB-treated rats at 24h after the cluster of spasms, the elevation of GABA, glutamine, glutamate, total creatine, macromolecule-plus lipids, and N-acetylaspartate levels after spasms were significantly attenuated by randomized BHB treatment (p<0.05). SIGNIFICANCE Prolonged administration of BHB directly suppresses development of spasms in a rat model of IS with acute stabilization of brain metabolites. Additionally, BHB appears to decrease the interests to other rats and improve memory responses.
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Affiliation(s)
- Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center, College of Medicine Ulsan University, Seoul, South Korea.
| | - Minyoung Lee
- Department of Pediatrics, Asan Medical Center, College of Medicine Ulsan University, Seoul, South Korea.
| | - Dong-Cheol Woo
- Asan Institute for Life Sciences, University of Ulsan College of Medicine, Seoul, South Korea.
| | - Dong Wook Kim
- Department of Pediatrics, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, South Korea.
| | - Tae-Sung Ko
- Department of Pediatrics, Asan Medical Center, College of Medicine Ulsan University, Seoul, South Korea.
| | - Libor Velíšek
- Departments of Cell Biology & Anatomy, Pediatrics and Neurology, New York Medical College, Valhalla, NY, United States.
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18
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Cortical involvement in focal epilepsies with epileptic spasms. Epilepsy Res 2014; 108:1572-80. [DOI: 10.1016/j.eplepsyres.2014.08.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/08/2014] [Accepted: 08/21/2014] [Indexed: 11/18/2022]
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19
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Abstract
This article focuses on the inflammatory processes in patients with generalized epilepsies. We specifically review the data regarding West, Lennox-Gastaut, and Landau-Kleffner syndromes as they have generalized clinical or electroencephalogram features. There is substantial evidence for a pathogenic implication of immune mechanisms in these epilepsies. Animal models and abnormalities in both cellular and humoral immunity support this hypothesis. They also appear to be particularly responsive to immunomodulatory therapies, which has raised the speculation that an unbalanced immune system may play an important role in the pathophysiology of these epileptic syndromes. In this article, we discuss clinical and experimental data that support the potential implication of immune mediated inflammation and immune response in the mechanism of these entities.
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20
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21
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Abstract
Epilepsy in children can be very different from epilepsy in adults, both in seizure type and epilepsy syndrome. The goal in treating children is seizure freedom, no treatment side effects, and function that is no different from the general population. In a significant percentage of patients, this goal remains unachievable, but many aspects of epilepsy are becoming clearer. This review will highlight 5 areas where progress is being made to achieve these goals in pediatric epilepsy. Specific research animal models are being developed to reflect the unique features of different pediatric epilepsies. As genetic syndromes are better identified, for some patients this has led to improved treatment. New advances in drug therapy have led to 3 new medications approved for children. More effective drug choices can now be recommended due to comparative drug trials and better overall care of children can be provided due to awareness of the comorbidities of epilepsy.
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Affiliation(s)
- Kelly Knupp
- University of Colorado Denver and Children's Hospital Colorado, Aurora
| | - Susan Koh
- University of Colorado Denver and Children's Hospital Colorado, Aurora
| | - Kristen Park
- University of Colorado Denver and Children's Hospital Colorado, Aurora
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22
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Abstract
Epilepsy accounts for a significant portion of the dis-ease burden worldwide. Research in this field is fundamental and mandatory. Animal models have played, and still play, a substantial role in understanding the patho-physiology and treatment of human epilepsies. A large number and variety of approaches are available, and they have been applied to many animals. In this chapter the in vitro and in vivo animal models are discussed,with major emphasis on the in vivo studies. Models have used phylogenetically different animals - from worms to monkeys. Our attention has been dedicated mainly to rodents.In clinical practice, developmental aspects of epilepsy often differ from those in adults. Animal models have often helped to clarify these differences. In this chapter, developmental aspects have been emphasized.Electrical stimulation and chemical-induced models of seizures have been described first, as they represent the oldest and most common models. Among these models, kindling raised great interest, especially for the study of the epileptogenesis. Acquired focal models mimic seizures and occasionally epilepsies secondary to abnormal cortical development, hypoxia, trauma, and hemorrhage.Better knowledge of epileptic syndromes will help to create new animal models. To date, absence epilepsy is one of the most common and (often) benign forms of epilepsy. There are several models, including acute pharmacological models (PTZ, penicillin, THIP, GBL) and chronic models (GAERS, WAG/Rij). Although atypical absence seizures are less benign, thus needing more investigation, only two models are so far available (AY-9944,MAM-AY). Infantile spasms are an early childhood encephalopathy that is usually associated with a poor out-come. The investigation of this syndrome in animal models is recent and fascinating. Different approaches have been used including genetic (Down syndrome,ARX mutation) and acquired (multiple hit, TTX, CRH,betamethasone-NMDA) models.An entire section has been dedicated to genetic models, from the older models obtained with spontaneous mutations (GEPRs) to the new engineered knockout, knocking, and transgenic models. Some of these models have been created based on recently recognized patho-genesis such as benign familial neonatal epilepsy, early infantile encephalopathy with suppression bursts, severe myoclonic epilepsy of infancy, the tuberous sclerosis model, and the progressive myoclonic epilepsy. The contribution of animal models to epilepsy re-search is unquestionable. The development of further strategies is necessary to find novel strategies to cure epileptic patients, and optimistically to allow scientists first and clinicians subsequently to prevent epilepsy and its consequences.
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Affiliation(s)
- Antonietta Coppola
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
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23
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Stafstrom CE, Arnason BGW, Baram TZ, Catania A, Cortez MA, Glauser TA, Pranzatelli MR, Riikonen R, Rogawski MA, Shinnar S, Swann JW. Treatment of infantile spasms: emerging insights from clinical and basic science perspectives. J Child Neurol 2011; 26:1411-21. [PMID: 21719797 DOI: 10.1177/0883073811413129] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Infantile spasms is an epileptic encephalopathy of early infancy with specific clinical and electroencephalographic (EEG) features, limited treatment options, and a poor prognosis. Efforts to develop improved treatment options have been hindered by the lack of experimental models in which to test prospective therapies. The neuropeptide adrenocorticotropic hormone (ACTH) is effective in many cases of infantile spasms, although its mechanism(s) of action is unknown. This review describes the emerging candidate mechanisms that can underlie the therapeutic effects of ACTH in infantile spasms. These mechanisms can ultimately help to improve understanding and treatment of the disease. An overview of current treatments of infantile spasms, novel conceptual and experimental approaches to infantile spasms treatment, and a perspective on remaining clinical challenges and current research questions are presented here. This summary derives from a meeting of specialists in infantile spasms clinical care and research held in New York City on June 14, 2010.
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Affiliation(s)
- Carl E Stafstrom
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53705, USA.
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24
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Chachua T, Yum MS, Velíšková J, Velíšek L. Validation of the rat model of cryptogenic infantile spasms. Epilepsia 2011; 52:1666-77. [PMID: 21854372 DOI: 10.1111/j.1528-1167.2011.03220.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether a new model of cryptogenic infantile spasms consisting of prenatal priming with betamethasone and postnatal trigger of spasms by N-methyl-D-aspartate (NMDA) responds to chronic adrenocorticotropic hormone (ACTH) treatment, and has electroencephalography (EEG) signature, efficacy of treatments, and behavioral impairments similar to those in human infantile spasms. METHODS Rats prenatally primed with betamethasone on gestational day 15 were used. Spasms were triggered with NMDA between postnatal days (P) 10 and 15 in a single session or in multiple sessions in one subject. The expression of spasms was compared to prenatally saline-injected controls. Effects of relevant treatments (ACTH, vigabatrin, methylprednisolone, rapamycin) were determined in betamethasone-primed rats. In the rats after spasms, behavioral evaluation was performed in the open field and elevated plus maze on P20-22. KEY FINDINGS NMDA at P10-15 (the rat "infant" period) triggers the spasms significantly earlier and in greater numbers in the prenatal betamethasone-exposed brain compared to controls. Similar to human condition, the spasms occur in clusters. Repeated trigger of spasms is associated with ictal EEG electrodecrements and interictal large-amplitude waves, a possible rat variant of hypsarrhythmia. Chronic ACTH treatment in a randomized experiment, and chronic pretreatment with methylprednisolone significantly suppress the number of spasms similar to the human condition. Pretreatment with vigabatrin, but not rapamycin, suppressed the spasms. Significant behavioral changes occurred following multiple bouts of spasms. SIGNIFICANCE The model of infantile spasms has remarkable similarities with the human condition in semiology, EEG, pharmacologic response, and long-term outcome. Therefore, the model can be used to search for novel and more effective treatments for infantile spasms.
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Affiliation(s)
- Tamar Chachua
- Department of Neurology, Albert Einstein College of Medicine Einstein/Montefiore Comprehensive Epilepsy Center, Bronx, New York, USA
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