Abstract
Acquired epilepsies can arise as a consequence of brain injury and result in unprovoked seizures that emerge after a latent period of epileptogenesis. These epilepsies pose a major challenge to clinicians as they are present in the majority of patients seen in a common outpatient epilepsy clinic and are prone to pharmacoresistance, highlighting an unmet need for new treatment strategies. Metabolic and homeostatic changes are closely linked to seizures and epilepsy, although, surprisingly, no potential treatment targets to date have been translated into clinical practice. We summarize here the current knowledge about metabolic and homeostatic changes in seizures and acquired epilepsy, maintaining a particular focus on mitochondria, calcium dynamics, reactive oxygen species and key regulators of cellular metabolism such as the Nrf2 pathway. Finally, we highlight research gaps that will need to be addressed in the future which may help to translate these findings into clinical practice.
Highlights
Epilepsy, a devastating disease, affects over 50 million people worldwide [1] and is defined by the occurrence of unprovoked seizures
The precise sources of reactive oxygen species (ROS) involved remain a matter of debate
It is likely that different sources are active at different time points during seizures and epilepsy, such as has cell death during seizure activity
Summary
A devastating disease, affects over 50 million people worldwide [1] and is defined by the occurrence of unprovoked seizures. We summarize current knowledge about metabolic and homeostatic changes in seizures and acquired epilepsy with a particular focus on mitochondria, Ca2+ dynamics, ROS and key regulators of cellular metabolism such as the nuclear factor erythroid 2–related factor 2 (Nrf2)pathway. It is not in the scope of this review to cover the extensive literature on genetic syndromes with mutations in genes coding for mitochondrial proteins or key enzymes of metabolism, which has been the subject of a number of other extensive reviews (e.g., [4,18]). Links to seizures and epilepsy have been established for all three mechanisms
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