Abstract

Acute repetitive seizures or seizure clusters are common in epileptic patients. Seizure clusters are associated with a high risk of developing status epilepticus and increased morbidity and mortality. Seizure clusters are also recognizable in spontaneous recurrent seizures (SRS) that occur in animal models of epilepsy. The electrical kindling of a limbic structure is a commonly used model of temporal lobe epilepsy. Although classic kindling over the course of a few weeks does not generally induce SRS, extended kindling over the course of a few months can induce SRS in several animal species. SRS in kindled cats often occur in clusters, but the existence of seizure clusters in rodent models of extended kindling remains to be demonstrated. We explored the existence of seizure clusters in mice following extended hippocampal kindling. Adult male mice (C57BL/6) experienced twice daily hippocampal stimulations and underwent continuous 24-hour electroencephalogram (EEG)-video monitoring after ≥80 stimulations. SRS events were recognized by EEG discharges and associated motor seizures. Seizure clusters, defined as ≥4 seizures per cluster and intra-cluster inter-seizure intervals ≤ 120 min, were observed in 19 of the 20 kindled mice. Individual mice showed variable seizure clusters in terms of cluster incidence and circadian-like expression patterns. For clusters consisting of 4–7 seizures and intra-seizure intervals ≤ 20 min, no consistent changes in inter-seizure intervals, EEG discharge duration, or motor seizure severity scores were observed approaching cluster termination. These results suggested that seizure clustering represents a prominent feature of SRS in hippocampal kindled mice. We speculate that, despite experimental limitations and confounding factors, systemic homeostatic mechanisms that have yet to be explored may play an important role in governing the occurrence and termination of seizure clusters.

Highlights

  • Many patients with epilepsy experience acute repetitive seizures or seizure clusters, which are associated with shorter-than-typical inter-seizure intervals [1,2,3,4,5]

  • Motor seizure scores were assessed according to the 5-stage Racine scale modified for mice [18, 43], and the corresponding scores are indicated above the EEG traces (Figure 2A)

  • The primary goal of our present study was to explore the existence of seizure clusters in SRS observed in hippocampal kindled mice

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Summary

Introduction

Many patients with epilepsy experience acute repetitive seizures or seizure clusters, which are associated with shorter-than-typical inter-seizure intervals [1,2,3,4,5]. The pathogenic mechanisms underlying seizure clusters are not well understood, but some risk factors have been recognized such as extra temporal or frontal lobe epilepsy, SE, refractory epilepsy, poor seizure control and increased duration of epilepsy. Certain behavioral changes such as changes in sleep disruption, stress, and medication changes or non-compliance can heighten individual vulnerability to seizure clusters [2,3,4,5]. Seizure clusters may result from discrete patterns that have yet to be recognized in individual patients, and further unraveling of seizure occurrence patterns may improve the management of epileptic seizures

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