Epileptic Pathology Research Articles

PDGFRβ+ cells in human and experimental neuro-vascular dysplasia and seizures

Introduction: Neuro-vascular rearrangement occurs in brain disorders, including epilepsy. Platelet-derived growth factor receptor beta (PDGFRβ) is used as a marker of perivascular pericytes. Whether PDGFRβ+ cell reorganization occurs in regions of neuro-vascular dysplasia associated with seizures is unknown. Methods: We used brain specimens derived from epileptic subjects affected by intractable seizures associated with focal cortical dysplasia (FCD) or temporal lobe epilepsy with hippocampal sclerosis (TLE-HS). Tissues from cryptogenic epilepsy, non-sclerotic hippocampi or peritumoral were used for comparison. An in vivo rat model of neuro-vascular dysplasia was obtained by pre-natal exposure to methyl-axozy methanoic acid (MAM). Status epilepticus (SE) was induced in adult MAM rats by intraperitoneal pilocarpine. MAM tissues were also used to establish organotypic hippocampal cultures (OHC) to further assess pericytes positioning at the dysplastic microvasculature. PDGFRβ and its colocalization with RECA-1 or CD34 were used to segregate perivascular pericytes. PDGFRβ and NG2 or IBA1 colocalization were performed. Rat cortices and hippocampi were used for PDGFRβ western blot analysis. Results: Human FCD displayed the highest perivascular PDGFRβ immunoreactivity, indicating pericytes, and presence of ramified PDGFRβ+ cells in the parenchyma and proximal to microvessels. Tissues deriving from human cryptogenic epilepsy displayed a similar pattern of immunoreactivity, although to a lesser extent compared to FCD. In TLE-HS, CD34 vascular proliferation was paralleled by increased perivascular PDGFRβ+ pericytes, as compared to non-HS. Parenchymal PDGFRβ immunoreactivity co-localized with NG2 but was distinct from IBA1+ microglia. In MAM rats, we found pericyte-vascular changes in regions characterized by neuronal heterotopias. PDGFRβ immunoreactivity was differentially distributed in the heterotopic and adjacent normal CA1 region. The use of MAM OHC revealed microvascular-pericyte dysplasia at the capillary tree lining the dentate gyrus (DG) molecular layer as compared to control OHC. Severe SE induced PDGFRβ+ immunoreactivity mostly in the CA1 region of MAM rats. Conclusion: Our descriptive study points to microvascular-pericyte changes in the epileptic pathology. The possible link between PDGFRβ+ cells, neuro-vascular dysplasia and remodeling during seizures is discussed.

The contribution of raised intraneuronal chloride to epileptic network activity.

Altered inhibitory function is an important facet of epileptic pathology. A key concept is that GABAergic activity can become excitatory if intraneuronal chloride rises. However, it has proved difficult to separate the role of raised chloride from other contributory factors in complex network phenomena, such as epileptic pathology. Therefore, we asked what patterns of activity are associated with chloride dysregulation by making novel use of Halorhodopsin to load clusters of mouse pyramidal cells artificially with Cl(-). Brief (1-10 s) activation of Halorhodopsin caused substantial positive shifts in the GABAergic reversal potential that were proportional to the charge transfer during the illumination and in adult neocortical pyramidal neurons decayed with a time constant of τ = 8.0 ± 2.8s. At the network level, these positive shifts in EGABA produced a transient rise in network excitability, with many distinctive features of epileptic foci, including high-frequency oscillations with evidence of out-of-phase firing (Ibarz et al., 2010). We show how such firing patterns can arise from quite small shifts in the mean intracellular Cl(-) level, within heterogeneous neuronal populations. Notably, however, chloride loading by itself did not trigger full ictal events, even with additional electrical stimulation to the underlying white matter. In contrast, when performed in combination with low, subepileptic levels of 4-aminopyridine, Halorhodopsin activation rapidly induced full ictal activity. These results suggest that chloride loading has at most an adjunctive role in ictogenesis. Our simulations also show how chloride loading can affect the jitter of action potential timing associated with imminent recruitment to an ictal event (Netoff and Schiff, 2002).

Cerebral cavernous malformations in the setting of focal epilepsies: pathological findings, clinical characteristics, and surgical treatment principles.

Cavernous cerebral malformations (CCMs) are a well-defined epilepsy-associated pathology. They represent lesions/conglomerates of abnormally configured vessels leading to seizures either as a result of physiological changes affecting the cerebral cortex immediately surrounding the CCM (an epileptogenic mechanism that is relevant for both temporal and extratemporal lesions), or as a result of promoting epileptogenicity in remote but anatomo-functionally connected brain regions (a mechanism that is particularly relevant for temporal lobe lesions). This review details the pathological findings in CCMs and discusses the mechanisms of epileptogenicity in this context. The bulk of the review will focus on therapeutic strategies. Medical therapy using antiepileptic drugs is recommended as a first-line therapy, but surgical removal of the CCM with the surrounding cortex should be pursued if seizures prove to be drug resistant. Early timing of the resection and complete removal of any associated epileptic pathology are critical for best outcomes. In addition to reviewing the available data from prior series, we present original research from two specialized epilepsy centers targeted at answering particularly pressing clinical questions mainly related to the ideal timing and extent of surgery. Further research is needed to define the best surgical strategies in patients with temporal lobe CCMs and structurally normal hippocampi.

Subsequent memory effect in intracranial and scalp EEG

Successful memory encoding is marked by increases in 30–100Hz gamma-band activity in a broad network of brain regions. Activity in the 3–8Hz theta band has also been shown to modulate memory encoding, but this effect has been found to vary in direction across studies. Because of the diversity in memory tasks, and in recording and data-analytic methods, our knowledge of the theta frequency modulations remains limited. The difference in the directionality of these theta effects could arise from a distinction between global cortical and deeper subcortical effects. To address this issue, we examined the spectral correlates of successful memory encoding using intracranial EEG recordings in neurosurgical patients and scalp EEG recordings in healthy controls. We found significant theta (3–8Hz) power modulations (both increases and decreases) and high gamma (44–100Hz) power increases in both samples of participants. These results suggest that (1) there are two separate theta mechanisms supporting memory success, a broad theta decrease present across both the cortex and hippocampus as well as a theta power increase in the frontal cortex, (2) scalp EEG is capable of resolving high frequency gamma activity, and (3) iEEG theta effects are likely not the result of epileptic pathology.

Nav1.1 haploinsufficiency in excitatory neurons ameliorates seizure-associated sudden death in a mouse model of Dravet syndrome

Dravet syndrome is a severe epileptic encephalopathy mainly caused by heterozygous mutations in the SCN1A gene encoding a voltage-gated sodium channel Nav1.1. We previously reported dense localization of Nav1.1 in parvalbumin (PV)-positive inhibitory interneurons in mice and abnormal firing of those neurons in Nav1.1-deficient mice. In the present study, we investigated the physiologic consequence of selective Nav1.1 deletion in mouse global inhibitory neurons, forebrain excitatory neurons or PV cells, using vesicular GABA transporter (VGAT)-Cre, empty spiracles homolog 1 (Emx1)-Cre or PV-Cre recombinase drivers. We show that selective Nav1.1 deletion using VGAT-Cre causes epileptic seizures and premature death that are unexpectedly more severe than those observed in constitutive Nav1.1-deficient mice. Nav1.1 deletion using Emx1-Cre does not cause any noticeable abnormalities in mice; however, the severe lethality observed with VGAT-Cre-driven Nav1.1 deletion is rescued by additional Nav1.1 deletion using Emx1-Cre. In addition to predominant expression in PV interneurons, we detected Nav1.1 in subpopulations of excitatory neurons, including entorhino-hippocampal projection neurons, a subpopulation of neocortical layer V excitatory neurons, and thalamo-cortical projection neurons. We further show that even minimal selective Nav1.1 deletion, using PV-Cre, is sufficient to cause spontaneous epileptic seizures and ataxia in mice. Overall, our results indicate that functional impairment of PV inhibitory neurons with Nav1.1 haploinsufficiency contributes to the epileptic pathology of Dravet syndrome, and show for the first time that Nav1.1 haploinsufficiency in excitatory neurons has an ameliorating effect on the pathology.

Why do some brains seize? Molecular, cellular and network mechanisms

Why do some brains seize? Molecular, cellular and network mechanisms

The information content of physiological and epileptic brain activity

Cerebral cortex is a highly sophisticated computing machine, feeding on information provided by the senses, which is integrated with other, internally generated patterns of neural activity, to trigger behavioural outputs. Bit by bit, we are coming to understand how this may occur, but still, the nature of the 'cortical code' remains one of the greatest challenges in science. As with other great scientific challenges of the past, fresh insights have come from a coalescence of different experimental and theoretical approaches. These theoretical considerations are typically reserved for cortical function rather than cortical pathology. This approach, though, may also shed light on cortical dysfunction. The particular focus of this review is epilepsy; we will argue that the information capacity of different brain states provides a means of understanding, and even assessing, the impact and locality of the epileptic pathology. Epileptic discharges, on account of their all-consuming and stereotyped nature, represent instances where the information capacity of the network is massively compromised. These intense discharges also prevent normal processing in surrounding territories, but in a different way, through enhanced inhibition in these territories. Information processing is further compromised during the period of post-ictal suppression, during interictal bursts, and also at other times, through more subtle changes in synaptic function. We also comment on information processing in other more physiological brain states.

The brain 5HTergic response to an acute sound stress in rats with generalized (absence and audiogenic) epilepsy

The brain serotoninergic (5HTergic) system of epileptic subjects can influence their vulnerability to stress. We studied the putative dependency of 5HT neurotransmission parameters on emotional stress, and the presence, types and severity of seizures using rats with genetic generalized (absence and/or audiogenic) epilepsy, of WAG/Rij and Wistar strains. The animals were stressed by exposure to a short aversive noise or left without sound stimulation. Tissue concentrations of 5HT, tryptophan (TRT) and 5-hydroxyindolacetic acid (5HIAA) were assessed by HPLC. The stressor activated the 5HTergic system within thalamus (5HIAA elevated), frontal cortex (5HT, TRT elevated), hypothalamus (increased TRT) in all rats. However, the normal (non-epileptic) rats displayed the highest response in the frontal cortex and the lowest one in the thalamus, as compared to the epileptic rats. Absence-epileptic rats exhibited higher thalamic 5HIAA increase than their controls. Significant correlations existed between propensity of absence epilepsy and 5HTergic parameters measured in the cortex and hypothalamus of absence-epileptic rats. No major difference was found between groups with and without audiogenic epilepsy. The results imply that the stress response depends on the presence of epileptic pathology and the seizure type and severity. The brain 5HT may be involved in the control of the paroxysms and behaviour in absence-epileptic subjects.

A Key Glycolytic Enzyme Plays a Dual Role in GABAergic Neurotransmission and in Human Epilepsy

We have previously described a new endogenous phosphorylation mechanism that maintains ionotropic gamma-aminobutyric acid receptor (GABAAR) function and have shown that the kinase involved is the glycolytic enzyme glyceraldehyde-3-phosphate dehydrogenase (GAPDH). This enzyme is closely associated with the receptor and phosphorylates the alpha1 subunit of the receptor. In a wealth of studies, a reduction in GABAergic neurotransmission has been suggested as a pathophysiological mechanism for human epilepsy. In this paper, we present evidence showing both reduced efficacy of this glycolysis-dependent GABAAR phosphorylation mechanism and of GABAergic inhibition in epileptogenic cortical tissue samples obtained during curative surgery of patients with partial seizures, as compared to non-epileptogenic human cortical tissue. This feature is not due to a reduction in the density of GABAAR alpha1 subunits in the epileptogenic tissue as evidenced by photoaffinity labeling. Maintaining the receptor in a phosphorylated state either by favoring the endogenous phosphorylation or by inhibiting a membrane-bound phosphatase sustains the GABAAR responses in the human epileptogenic cortex. The deficiency in endogenous phosphorylation and the associated decreased GABAAR function can account for transient failures of GABAergic inhibition and may favor seizure initiation and propagation. These findings suggest a functional link between epileptic pathology and the regional cerebral glucose hypometabolism observed in patients with partial epilepsies, since the dysfunction of the GABAergic mechanism is dependent on locally produced glycolytic ATP. They also point to new targets for developing molecules active in drug-resistant epilepsies.

Heat Shock Protein‐27 Is Upregulated in the Temporal Cortex of Patients with Epilepsy

Heat shock protein-27 (HSP-27) belongs to the group of small heat shock proteins that become induced in response to various pathologic conditions. HSP-27 has been shown to protect cells and subcellular structures, particularly mitochondria, and serves as a carrier for estradiol. It is a reliable marker for tissues affected by oxidative stress. Oxidative stress and related cellular defence mechanisms are currently thought to play a major role during experimentally induced epileptic neuropathology. We addressed the question whether HSP-27 becomes induced in the neocortex resected from patients with pharmacoresistant epilepsy. Human epileptic temporal neocortex was obtained during neurosurgery, and control tissue was obtained at autopsy from subjects without known neurologic diseases. The tissues were either frozen for Western blot analysis or fixed in Zamboni's fixative for the topographic detection of HSP-27 at the cellular level by means of immunohistochemistry. HSP-27 was highly expressed in all epilepsy specimens and in the cortex of a patient who died in the final stage of multiple sclerosis (positive control), whereas only low amounts of HSP-27 were detectable in control brains. In epilepsy patients, HSP-27 was present in astrocytes and in the walls of blood vessels. The intracortical distribution patterns varied strongly among the epilepsy specimens. These results demonstrate that HSP-27 becomes induced in response to epileptic pathology. Although the functional aspects of HSP-27 induction during human epilepsy have yet to be elucidated, it can be concluded that HSP-27 is a marker for cortical regions in which a stress response has been caused by seizures.

The value of neuroimaging in diagnosis of epilepsy

Neuroimaging examines the relationship between abnormalities of brain function in epilepsy patients (seizures, impaired cognitive function, psychiatric co-morbidity etc.) and focal or more widespread brain pathology. Since the mid-1980s, the introduction of magnetic resonance imaging (MRI) into clinical neurology has had an impact on the diagnosis, treatment, and research of epilepsy only comparable with the advent of the electroencephalography (EEG) fifty years ago. MRI plays the important role of identifying single or multiple structural lesions responsible for the epileptic seizures. Thus, visual assessment of MRI plays an important role in the differentiation between symptomatic, cryptogenic, and idiopathic epilepsies. This diagnostic step leads to therapeutic decisions (medical treatment vs. surgery) and prognostic evaluations. If a structural lesion identified with MRI correlates with seizure-type, EEG and other clinical data, the likelihood of rendering the patient seizure free with epilepsy surgery is increased. Clinical research into epilepsy uses quantitative MRI (volumetry, T2-relaxometry, magnetic resonance spectroscopy [MRS], voxel-based morphometry) to reduce those cases initially labeled as cryptogenic. Quantitative MRI questions the belief that there is epilepsy without structural brain abnormality at all. Functional MRI (fMRI), positron emission tomography (PET) and single photon emission computed tomography (SPECT) demonstrate changes associated with epileptic seizures and pathology, and changes associated with EEG abnormalities and their cessation. Functional neuroimaging is also used for the identification of functional brain tissue before surgery. Physiologically or pathologically active neuronal tissue is believed to be identified by glucose or oxygen consumption (PET), cerebral blood flow (PET, SPECT, perfusion MRI), and cerebral blood oxygenation (blood oxygenation level dependent [BOLD] fMRI). PET also offers the opportunity to visualize the in-vivo distribution of neuronal receptors which are implicated in the generation, the spread, and the cessation of seizures.

Absence of sleep spindles in human medial and basal temporal lobes.

All-night recordings from subdural electrocorticographic (ECoG) electrodes on the human medial and basal temporal lobes were analysed to examine spindling activities during sleep. Subjects were three males and three females who were candidates for neurosurgical treatments of partial epilepsy. Subdural electrodes were attached to the medial and basal temporal lobe cortices, allowing ECoG and electroencephalogram from the scalp vertex (Cz EEG) to be recorded simultaneously during all night sleep. In one case, subdural electrodes were attached also on the parietal lobe. Fast Fourier transformation (FFT) analyses were performed on the ECoG and Cz EEG signals. No organized sleep spindles or sigma band (12-16 Hz) peaks in FFT power spectra were observed from the medial or basal temporal lobes of the non-epileptogenic hemispheres during non-rapid eye movement (NREM) sleep. In a case with parietal electrodes, organized spindle bursts were observed in parietal signals synchronized with Cz spindles. Although delta band (0.3-3 Hz) power from both the medial and basal temporal lobes fluctuated across each night as expected, sigma activity changed little. However, 14 Hz oscillatory bursts were observed in the medial basal temporal lobe of epileptogenic hemisphere in two cases and bilaterally in one case during not only NREM sleep but rapid eye movement (REM) sleep and wakefulness. From the present study we conclude that sleep spindle activities are absent in the medial and basal temporal lobes. Fourteen Hz oscillatory bursts observed from the medial or basal temporal lobe in some cases were not considered to be sleep spindles since they also appeared during REM sleep and wakefulness. These waveforms could have originated due to epileptic pathology, since they frequently appeared in epileptic regions.

Cerebral computed tomography and electroencephalography compared with neuropsychological findings in systemic lupus erythematosus.

Central nervous system involvement was evaluated in 36 patients with systemic lupus erythematosus (SLE) using cerebral computed tomography (CT), electroencephalography (EEG), and a neuropsychological test battery. The purpose was to investigate whether brain dysfunction as assessed by comprehensive neuropsychological investigation is associated with findings of routine investigation methods such as CT and EEG which are available in most hospitals. Abnormal EEG was found in 19%, and CT revealed cerebral atrophy in 47% of SLE patients. Few neuropsychological functions were affected by the presence of abnormal EEG, cerebral atrophy, or infarcts. Significant associations were found only between cortical atrophy and impairment of tactile spatial problem-solving and motor dexterity, and between cortical infarcts and motor dexterity in the dominant hand. The value of conventional EEG in assessing cerebral SLE is negligible, except for identifying epileptic activity and focal pathology. Cerebral CT has little relevance in predicting brain dysfunction as established by neuropsychological assessment in SLE, except for detecting cortical atrophy and infarcts.

Glutamate currents in morphologically identified human dentate granule cells in temporal lobe epilepsy.

Glutamate-receptor-mediated synaptic transmission was studied in morphologically identified hippocampal dentate granule cells (DGCs; n = 31) with the use of whole cell patch-clamp recording and intracellular injection of biocytin or Lucifer yellow in slices prepared from surgically removed medial temporal lobe specimens of epileptic patients (14 specimens from 14 patients). In the current-clamp recording, low-frequency stimulation of the perforant path generated depolarizing postsynaptic potentials that consisted of excitatory postsynaptic potentials and phase-inverted inhibitory postsynaptic potentials mediated by the gamma-aminobutyric acid-A (GABA(A)) receptor at a resting membrane potential of -62.7 +/- 2.0 (SE) mV. In the voltage-clamp recording, two glutamate conductances, a fast alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA)-receptor-mediated excitatory postsynaptic current (EPSC; AMPA EPSC) and a slowly developing N-methyl-D-aspartate (NMDA)-receptor-mediated EPSC (NMDA EPSC), were isolated in the presence of a GABA(A) receptor antagonist. NMDA EPSCs showed a voltage-dependent increase in conductance with depolarization by exhibiting an N-shaped current-voltage relationship. The slope conductance of the NMDA EPSC ranged from 1.1 to 9.4 nS in 31 DGCs, reaching up to twice the size of the AMPA conductance. This widely varying size of the NMDA conductance resulted in the generation of double-peaked EPSCs and a nonlinear increase of the slope conductance of up to 37.5 nS with positive membrane potentials, which resembled "paroxysmal currents," in a subpopulation of the neurons. In contrast, AMPA EPSCs, which were isolated in the presence of an NMDA receptor antagonist (2-amino-5-phosphonovaleric acid), showed voltage-independent linear changes in the current-voltage relationship and were blocked by 6-cyano-7-nitroquinoxaline-2,3-dione. The AMPA conductance showed little variance, regardless of the size of the NMDA conductance of a given neuron. The average AMPA slope conductance was 5.28 +/- 0.65 (SE) nS in 31 human DGCs. This value was similar to AMPA EPSC conductances in normal rat DGCs (5.35 +/- 0.52 nS, mean +/- SE; n = 55). Dendritic morphology and spine density were quantified in the individual DGCs to assess epileptic pathology. Dendritic spine density showed an inverse correlation (r2 = 0.705) with a slower rise time and a longer half-width of the excitatory postsynaptic potentials mediated by the NMDA receptor. It is concluded that both AMPA and NMDA EPSCs contribute to human DGC synaptic transmission in epileptic hippocampus. However, a wide range of changes in the slope conductance of the NMDA EPSCs suggests that the NMDA-receptor-mediated conductance could be altered in human epileptic DGCs. These changes may influence the generation of chronic subthreshold epileptogenic synaptic activity and give rise to pathological excitation leading to epileptic seizures and dendritic pathology.

DYSPHAGIA IN PATIENTS WITH SPASTIC TETRAPLEGIA AND MENTAL RETARDATION

Spastic tetraplegia (TPL) is considered to be a particular form of cerebral palsy. It is characterised by its association with severe mental retardation, serious epileptic pathology, visual defects, orthopaedic deformities and pseudobulbar paralysis. The latter condition leads to problems in feeding and breathing in 80% of patients with TPL thus compromising day-to-day primary care. Eighty-nine patients aged from 2 years to 45 years (mean age 22) with TPL and severe mental retardation were investigated with a videofluoroscopic examination. Episodes of pneumonia or bronchitis, or the presence of bronchial secretions characterise the clinical history of the majority of these patients who had feeding difficulties. False tracheal passageways (laryngeal aspiration) by nature silent, were documented in 71% of subjects. In particular, the extent of the bronchographical image, present in 50% of patients is only very accentuated in 12% of patients. It can be seen from this that false tracheal passageways, however frequent in these patients, do not necessarily cause serious problems in connection with the respiratory airways. A further cause of respiratory problems must also be attributed to the presence of gastroesophageal refluxes, found in at least 36% of the patients who were examined.

Evaluation of abnormal low frequency magnetic activity (AL-FMA) in epilepsy

MEG attempts to define regions of epileptic pathology in patients with a seizure history are compromised by several factors. First, most studies are interictal in nature, an issue of concern to many epileptologists. Also, in some cases epileptic magnetic field patterns are highly complex and not amenable to simple single or even multiple dipole modeling. A final concern is the observation that most patients have seizures only very intermittently, with their interictal EEG often devoid of epileptic spikes and sharpwaves.

Increased NMDA responses and dendritic degeneration in human epileptic hippocampal neurons in slices.

To investigate physiological properties of epileptogenic neurons in relation to epileptic pathology, intracellular recording and intracellular dye injection after the recording were obtained in dentate granule cells in slices prepared from excised human epileptic hippocampus in which selective cell degeneration has been documented. Markedly prolonged excitatory postsynaptic potentials (EPSPs) were recorded in 67% of the total neurons sampled during perforant path stimulation. Such EPSPs were voltage dependent and sensitive to the NMDA receptor antagonist D-2-amino-5-phosphonovaleric acid. Neurons that generated the increased N-methyl-D-aspartate (NMDA) responses were accompanied by abnormal dendritic morphology, i.e. loss of dendritic spines and development of beaded shafts. These findings suggest that an NMDA receptor-mediated toxic process that impinges specifically on dendritic components might take place in intractable epilepsy.

Activity of human hippocampal formation and amygdala neurons during memory testing

Single and multiple unit recordings were made from fine wires stereotaxically implanted in the hippocampus (HC), hippocampal gyrus (HCG), and amygdala (Am) of psychomotor epileptics. During a series of memory and control tests presented on slides, 21 of 155 HCG units, 15 of 59 HC units, and 2 of 54 Am units showed what appeared to be simple phasic or tonic visual responses. Twenty-seven other units, found only in the HCG, changed firing only during slides requiring a choice (‘choice units’). A given choice unit responded during choices indicated verbally or manually, and during tasks requiring recall of Recent Memory, various visual discriminations, and expressions of preference. Choice units were not affected by sensory stimulation or motor activity in contexts not requiring choice. Phasically inhibited choice units had higher firing rates and lower signal-to-noise ratios than tonically excited units. Whether an electrode recorded a choice unit was unrelated to if it recorded a response to hyperventilation, or was in an area of epileptic pathology. Recordings were also made during an interview lasting several hours and eliciting a wide range of behaviors. Five of the 131 HCG units fired in repeated extended bursts, at least 50 times background during recall of word pairs or of the patient's hospital room. The unit response did not occur during numerous control tasks possessing similar overt sensory, motor, and social concomitants, but not requiring Recent Memory.