Maximal Seizure Research Articles

Have epilepsy outcomes changed for children with tuberous sclerosis complex in Queensland, Australia?

Historically, epilepsy has been the most frequently presenting feature of tuberous sclerosis complex (TSC). Advances in TSC health care have occurred over the past decade; thus, we studied whether TSC epilepsy outcomes have changed. A retrospective chart review was undertaken for all children with TSC in Queensland, Australia. Epilepsy outcome and TSC diagnosis data were extracted, and data were compared between children born before 2012 with those born in or after 2012. In this retrospective cohort, TSC diagnosis in children born in or after 2012 is now predominantly antenatal (51%, p < .05). Most patients with epilepsy are now known to have TSC before they develop epilepsy. Despite earlier TSC diagnosis, the frequency of epilepsy (85%) has not changed (p = .92), but diagnosis trends toward an earlier age (median = 3 months for patients born in or after 2012 vs. 5.5 months for those born before 2012, p = .23). Most (95%) patients had focal seizures as their initial clinical seizure type; it was rare (5%) for epileptic spasms (ES) to be the initial seizure type. The frequency of ES was lower in patients born in or after 2012 (36% vs. 50%, p = .27). Infantile (<24 months) onset ES was not associated with worse epilepsy outcome. Late onset ES was seen in 14%, and these patients hada lower rate of epilepsy remission. Lennox-Gastaut syndrome was seen in 7%. Febrile/illness-related status epilepticus occurred in 12% of patients, between 1 and 4 years of age. Despite many (78%) patients having multiple daily seizures at maximal seizure frequency, and 74% meeting criteria for treatment-refractory epilepsy, most patients achieved epilepsy remission (66%), either with epilepsy surgery (47%) or with age (53%). At the time of inclusion in this study, only 21% of patients had uncontrolled frequent (daily to 3 monthly) seizures and 14% had uncontrolled infrequent (3 monthly to <2 yearly) seizures. This study provides updated information that informs the counseling of parents of newly diagnosed pediatric TSC patients.

Molybdenum Disilicide (MoSi2) and Ferrophosphorus Particles (FemPn) Improve the Anti-Seizure Properties of Copper-Tin-Bismuth Composites under Conformal and Nonconformal Contacts

Seizure is a severe accident that can abruptly stop or even damage running equipment. Improving the anti-seizure properties of friction pair materials is also crucial as lubricating and wear resistance. While the tribological performances of molybdenum disilicide (MoSi2) and ferrophosphorus (FemPn) particle-doped copper-tin-bismuth (Cu-Sn-Bi) composites have been investigated in previous studies, the specific effects of MoSi2 and FemPn particles on the anti-seizure property of Cu-Sn-Bi materials remain unclear. This study explores the seizure resistance of Cu-Sn-Bi composites containing MoSi2 and/or FemPn under conformal and nonconformal contact conditions. The materials were prepared using powder sintering technology, and the metallographic structures of four types of self-lubricating copper composites were observed. Seizure resistance under starved lubrication conditions was investigated, and the worn surfaces under different contact types were discussed and analyzed. The results indicate that the addition of MoSi2 and/or FemPn particles effectively refines the grain size, and these particles exhibit different distribution trends after powder sintering. The MoSi2 and FemPn particles improved the maximum seizure load of copper-based composite samples by 66.67% and 84.62%, respectively. The seizure forms under different contact types were also discussed.

Aquaporin-4 inhibition attenuates Pentylenetetrazole-induced behavioral seizures and cognitive impairments in kindled rats

Epilepsy is a neurological condition distinguished by recurrent and unexpected seizures. Astrocytic channels and transporters are essential for maintaining normal neuronal functionality. The astrocytic water channel, aquaporin-4 (AQP4), which plays a pivotal role in regulating water homeostasis, is a potential target for epileptogenesis. In present study, we examined the effect of different doses (10, 50, 100 μM and 5 mM) of AQP4 inhibitor, 2-nicotinamide-1, 3, 4-thiadiazole (TGN-020), during kindling acquisition, on seizure parameters and seizure-induced cognitive impairments. Animals were kindled by injection of pentylenetetrazole (PTZ: 37.5 mg/kg, i.p.). TGN-020 was administered into the right lateral cerebral ventricle 30 min before PTZ every alternate day. Seizure parameters were assessed 20 min after PTZ administration. One day following the last PTZ injection, memory performance was investigated using spontaneous alternation in Y-maze and novel object recognition (NOR) tests. The inhibition of AQP4 during the kindling process significantly decreased the maximal seizure stage and seizure duration (two-way ANOVA, P = 0.0001) and increased the latency of seizure onset and the number of PTZ injections required to induce different seizure stages (one-way ANOVA, P = 0.0001). Compared to kindled rats, the results of the NOR tests showed that AQP4 inhibition during PTZ-kindling prevented recognition memory impairment. Based on these results, AQP4 could be involved in seizure development and seizure-induced cognitive impairment. More investigation is required to fully understand the complex interactions between seizure activity, water homeostasis, and cognitive dysfunction, which may help identify potential therapeutic targets for these conditions.

Relationship of Neonatal Seizure Burden Before Treatment and Response to Initial Antiseizure Medication

To assess among a cohort of neonates with hypoxic-ischemic encephalopathy (HIE) the association of pretreatment maximal hourly seizure burden and total seizure duration with successful response to initial antiseizure medication (ASM). This was a retrospective review of data collected from infants enrolled in the HEAL Trial (NCT02811263) between January 25, 2017, and October 9, 2019. We evaluated a cohort of neonates born at ≥36weeks of gestation with moderate-to-severe HIE who underwent continuous electroencephalogram monitoring and had acute symptomatic seizures. Poisson regression analyzed associations between (1) pretreatment maximal hourly seizure burden, (2) pretreatment total seizure duration, (3) time from first seizure to initial ASM, and (4) successful response to initial ASM. Among 39 neonates meeting inclusion criteria, greater pretreatment maximal hourly seizure burden was associated with lower chance of successful response to initial ASM (adjusted relative risk for each 5-minute increase in seizure burden 0.83, 95% CI 0.69-0.99). There was no association between pretreatment total seizure duration and chance of successful response. Shorter time-to-treatment was paradoxically associated with lower chance of successful response to treatment, although this difference was small in magnitude (relative risk 1.007, 95% CI 1.003-1.010). Maximal seizure burden may be more important than other, more commonly used measures in predicting response to acute seizure treatments.

Reduced uterine perfusion increases hippocampal cannabinoid receptor 1 expression and reduces pentylenetetrazol-induced seizures after rimonabant pre-treatment

Eclampsia, new-onset seizures in pregnant women, can affect women with preeclampsia, a hypertensive pregnancy disorder. Eclampsia is associated with high maternal and fetal morbidity and mortality. The mechanisms contributing to increased risk of seizures in preeclampsia patients are not fully known. One potential mechanism could be abnormal endocannabinoid system activity, and abnormal neuro-modulation. Indeed, increased placental cannabinoid receptor 1 (CB1R) expression and reduced serum concentration of anandamide, a ligand that activates the CB1R, have been reported in preeclampsia patients. We hypothesized that reduced uterine perfusion pressure (RUPP) in mice leads to differences in hippocampal CB1R expression and that inhibiting CB1R activity will increase seizure sensitivity in RUPP mice. Pregnant mice underwent sham (n=5) or RUPP (n=5) surgery on gestational day (GD) 13.5. On GD 18.5, the hippocampus was harvested and processed for Western blot to analyze the expression of CB1R in homogenates, synaptosomal fraction, and cytosolic fraction of the hippocampus. To determine if blocking CB1R increases sensitivity to pentylenetetrazol (PTZ)-induced seizures, additional sham (n=7) and RUPP (n=7) mice were pretreated with 10 mg/kg of rimonabant, video monitored for 15 minutes, injected with 40 mg/kg of PTZ and video monitored for an additional 30 minutes before being sacrificed. Seizures were scored using a modified 7-point Racine scale. In hippocampal homogenates, CB1R expression increased in RUPP mice (p=0.056). There was no difference in CB1R expression in the synaptosomal fraction (p=0.095); however, there was an increase in CB1R expression in the cytosolic fraction of RUPP mice (p=0.016). Immunofluorescence analysis showed increased CB1R colocalization on both glutamate- and GABA- releasing neurons within hippocampal CA1 (p=0.029; p=0.057, respectively). CB1R blockade induced a maximum seizure score of 4 in both groups but led to higher seizure scores over time in RUPP mice (p=0.025). PTZ injection after rimonabant pretreatment increased seizure scores in sham (p&lt;0.05), non-significantly increased scores in RUPP (p=0.075), increased duration of seizures in sham but not RUPP mice (p=0.021; p=0.245, respectively), and reduced latency to seizures in sham mice (p=0.019) while there was no further decrease in seizure latency in RUPP (p=0.374) mice. Furthermore, during the first 15 minutes of PTZ exposure, RUPP mice had lower seizure scores over time than sham [p(TimexRUPP)=0.002] following CB1R blockade. These data suggest that RUPP induces abnormal CB1R expression, resulting in increased sensitivity to seizures after CB1R blockade, while protecting against worse seizures when challenged with the pro-convulsant, PTZ. NIH R00HL129192, R00HL129192-S1, COBRE Pilot Grant, T32HL105324, William Townsend Porter Pre-Doctoral Fellowship from the American Physiological Society, 1F99NS129125-01. This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Nicorandil Exerts Anticonvulsant Effects in Pentylenetetrazol-Induced Seizures and Maximal-Electroshock-Induced Seizures by Downregulating Excitability in Hippocampal Pyramidal Neurons.

N-(2-hydroxyethyl) nicotinamide nitrate (nicorandil), a nitrate that activates adenosine triphosphate (ATP)-sensitive potassium (KATP) channels, is generally used in the treatment of angina and offers long-term cardioprotective effects. It has been reported that several KATP channel openers can effectively alleviate the symptoms of seizure. The purpose of this study was to investigate the improvement in seizures induced by nicorandil. In this study, seizure tests were used to evaluate the effect of different doses of nicorandil by analysing seizure incidence, including minimal clonic seizure and generalised tonic-clonic seizure. We used a maximal electroshock seizure (MES) model, a metrazol maximal seizure (MMS) model and a chronic pentylenetetrazol (PTZ)-induced seizure model to evaluate the effect of nicorandil in improving seizures. Each mouse in the MES model was given an electric shock, while those in the nicorandil group received 0.5, 1, 2, 3 and 6mg/kg of nicorandil by intraperitoneal injection, respectively. In the MMS model, the mice in the PTZ group and the nicorandil group were injected subcutaneously with PTZ (90mg/kg), and the mice in the nicorandil group were injected intraperitoneally with 1, 3 and 5mg/kg nicorandil, respectively. In the chronic PTZ-induced seizure model, the mice in the PTZ group and the nicorandil group were injected intraperitoneally with PTZ (40mg/kg), and the mice in the nicorandil group were each given 1 and 3mg/kg of PTZ at a volume of 200nL. Brain slices containing the hippocampus were prepared, and cell-attached recording was used to record the spontaneous firing of pyramidal neurons in the hippocampal CA1 region. Nicorandil (i.p.) significantly increased both the maximum electroconvulsive protection rate in the MES model and the seizure latency in the MMS model. Nicorandil infused directly onto the hippocampal CA1 region via an implanted cannula relieved symptoms in chronic PTZ-induced seizures. The excitability of pyramidal neurons in the hippocampal CA1 region of the mice was significantly increased after both the acute and chronic administration of PTZ. To a certain extent, nicorandil reversed the increase in both firing frequency and proportion of burst spikes caused by PTZ (P < 0.05). Our results suggest that nicorandil functions by downregulating the excitability of pyramidal neurons in the hippocampal CA1 region of mice and is a potential candidate for the treatment of seizures.

A six-month prospective, randomised, double-blinded, placebo-controlled, crossover, dietary trial design to investigate the potential of psychobiotics on seizure semiology and comorbidities in canine epilepsy: study protocol

BackgroundEpilepsy is the most common chronic neurological disease in dogs. More than two-thirds of these patients suffer from associated behavioural comorbidities. The latter could have their origin in partially overlapping pathomechanisms, with the intestinal microbiome as a potential key link between them. The current arsenal of drugs for epilepsy management remains limited. Most canine patients continue to have seizures despite treatment and the occurrence of comorbidities is not sufficiently addressed, limiting quality of life of affected dogs and owners. Therefore, novel additional epilepsy management options are urgently needed. The microbiome-gut-brain axis may serve as a new target for the development of innovative multimodal therapeutic approaches to overcome current shortcomings in epilepsy management.MethodsA six-month prospective, randomised, double-blinded, placebo-controlled, crossover, dietary trial was designed to investigate the potential of the psychobiotic Bifidobacterium longum on behavioural comorbidities in canine epilepsy. Seizure semiology will be evaluated as a secondary outcome measure. Thirty-four privately owned dogs are planned to be included in the ongoing study meeting the following inclusion criteria: Dogs displaying increased anxiety/fear behaviour since the start of the idiopathic epilepsy. Tier II confidence level of the International Veterinary Epilepsy Task Force for the diagnosis of idiopathic epilepsy, with a maximum seizure interval of 3 month and a minimum of three generalised seizures within that period and chronically treated with at least one antiseizure drug without improvement in seizure frequency Each dog will receive the allocated supplement (probiotic vs. placebo) alongside its normal diet for a 3-month period. After a three-week wash out period, the second phase starts by administering the respective other supplement for another 3 months.DiscussionThe current study considers modern high-quality standards for epilepsy medication trials. Common biasing effects should be limited to a possible minimum (regression-to-the mean effect, placebo effect, observer effect), ensuring a high validity and accuracy of the acquired results, thus enabling a representative nature of the efficacy of Bifidobacterium longum as add-on supplement for dogs suffering from epilepsy and its comorbidities. This publication should provide a description of the study procedure and data acquisition methods, including prognosed statistical analysis.

Dietary Zinc Differentially Regulates the Effects of the GPR39 Receptor Agonist, TC-G 1008, in the Maximal Electroshock Seizure Test and Pentylenetetrazole-Kindling Model of Epilepsy.

The G-protein coupled receptor 39 (GPR39) is gaining increasing attention as a target for future drugs, yet there are gaps in the understanding of its pharmacology. Zinc is an endogenous agonist or an allosteric modulator, while TC-G 1008 is a synthetic, small molecule agonist. Zinc is also a positive allosteric modulator for the activity of TC-G 1008 at GPR39. Activation of GPR39 by TC-G 1008 facilitated the development of epileptogenesis in the pentylenetetrazole (PTZ)-induced kindling model of epilepsy. Congruently, TC-G 1008 decreased the seizure threshold in the maximal electroshock seizure threshold (MEST) test. Here, we investigated the effects of TC-G 1008 under the condition of zinc deficiency. Mice were fed a zinc-adequate diet (ZnA, 50 mg Zn/kg) or a zinc-deficient diet (ZnD, 3 mg Zn/kg) for 4 weeks. Following 4 weeks of dietary zinc restriction, TC-G 1008 was administered as a single dose and the MEST test was performed. Additional groups of mice began the PTZ-kindling model during which TC-G 1008 was administered repeatedly and the diet was continued. TC-G 1008 administered acutely decreased the seizure threshold in the MEST test in mice fed the ZnD diet but not in mice fed the ZnA diet. TC-G 1008 administered chronically increased the maximal seizure severity and the percentage of fully kindled mice in those fed the ZnA diet, but not in mice fed the ZnD diet. Our data showed that the amount of zinc in a diet is a factor contributing to the effects of TC-G 1008 in vivo.

Tonic and phasic stimulations of ventral tegmental area have opposite effects on pentylenetetrazol kindled seizures in mice

Dopamine may be involved in the anticonvulsant action of deep brain stimulation (DBS). Therefore, ventral tegmental area (VTA), as a brain dopaminergic nucleus, may be a suitable target for DBS anticonvulsant action. This study investigated the effect of tonic and phasic stimulations of the VTA on seizure parameters. Seizures were induced in adult mice by sequential injections of a sub-convulsive dose of 35 mg/kg pentylenetetrazole (PTZ) every 48 h to develop the chemical kindling until the mice reached full kindled state (showing three consecutive seizure stages 4 or 5). Fully kindled mice received DBS once a day as tonic (square waves at 1 Hz; pulse duration: 200 μs; intensity: 300 μA; 600 pulses in 10 min) or phasic (square waves at 100 Hz; pulse duration: 200 μs; intensity: 300 μA; 8 trains of 10 pulses at 1 min interval; 800 pulses in 10 min) stimulations applied into their VTA for 4 days. A single dose of PTZ was injected after each DBS. Simultaneously electrocorticography and video recordings were performed during the seizure for accuracy in seizure severity parameters detection. Tonic but not phasic stimulation significantly decreased the epileptiform discharge duration and the seizure behavioral parameters such as maximum seizure stage, stage 5 duration, seizure duration. In addition, focal to generalized seizure latency increased following VTA tonic stimulation. These data suggest that tonic (but not phasic) stimulation of VTA before PTZ injection on 4 test days had anticonvulsant effects on PTZ-kindled seizures.

Cumulative effects of antiseizure medication on intelligence in children with focal epilepsy

Antiseizure medication may have long-term effects on the neurodevelopment of children. We aimed to investigate the association between cumulative antiseizure medication load and intelligence quotient (IQ) in relation to brain volume and cortical thickness. A retrospective analysis of children with focal epilepsy who underwent neuropsychological assessment and MRI between the ages of 5-12 years in a tertiary epilepsy centre was performed. Cumulative medication load was presented in medication years. We studied the association between total medication load and IQ with multivariable linear regression, corrected for epilepsy-related confounders: age at first treatment, aetiology, maximum seizure frequency, duration of active epilepsy, history of secondary generalized seizures, history of status epilepticus, and the number of antiseizure medications used at time of neuropsychological assessment. We included 59 children. Median medication load was 5.3 medication-years (interquartile range: 2.0 – 11.1) and mean total IQ (± standard deviation) was 77.4±18.9. A significant negative relation between medication load and total IQ was found with a decrease of 1.2 IQ-points per medication-year (95% confidence interval: -2.0 to -0.3) after correcting for confounders. Medication load and IQ were both not significantly associated with brain volume or cortical thickness. Higher cumulative medication load is associated with lower total IQ after adjusting for epilepsy-related confounders. We found no evidence to support the hypothesis that the medication-related IQ decrease was mediated by volumetric brain changes. However, these results should be interpreted with caution, and prospective, longitudinal confirmation of these findings is required. Lastly, it should be stressed that effective seizure prevention often outweighs the potential negative effects of antiseizure medication.

Glial cells inhibition affects the incidence of metaplasticity in the hippocampus of Pentylentetrazole-induced kindled rats

Epilepsy is characterized by the unpredictability but recurrence of seizures caused by the synchronized aberrant firing of neuronal populations. It has been shown that astrocytes (one of the most prominent glial cells) are ideally positioned to induce or contribute to neural network synchronization. Although astrocytes cannot generate action potentials, they have the capacity to sense and respond to neuronal activity, which allows them to function as homeostatic regulators of synaptic interactions. Considering the necessity of astrocyte-neuron bidirectional interactions in synaptic transmission and plasticity, in the current study, the role of astrocytes in synaptic metaplasticity and resultant behavioral seizures induced by Pentylentetrazole (PTZ) was assessed.Rats were kindled by intraperitoneal (i.p.) injection of PTZ (30 mg/kg/48 h). A glial cell inhibitor, Fluorocitrate (FC), was injected into the right lateral cerebral ventricle of the rat 30 min before PTZ during kindling progress. The maximal seizure stage (SS), stage 2 and 4 latency (S2L, S4L), stage 4 and 5 duration (S4D, S5D), and seizure duration (SD) were all assessed 20 min after PTZ administration by observation. Following Schaffer collateral stimulation, in vivo field, potential recordings from the CA1 area of the hippocampus were employed to assess the metaplasticity induced in kindled rats.The inhibition of glial cells during the kindling process significantly lowered SS, S4D&S5D and increased S4L (Two-way ANOVA, Bonferroni Posttest, P < 0.05, P < 0.01, and P < 0.001). In comparison to the control group, electrophysiological data demonstrated that HFS-induced LTP in kindled animals was decreased (Unpaired t-test, P < 0.05). Glial cell inhibition prevented PTZ's effect on LTP.Our data imply that kindling altered CA1 pyramidal neurons' vulnerability to synaptic plasticity. This shift in neuronal plasticity (metaplasticity) is mediated in part by glial cells and is important in the formation of seizure symptoms. As a result, glial cell inhibition was found to alleviate seizure behavior.

Transcranial photobiomodulation add-on therapy to valproic acid for pentylenetetrazole-induced seizures in peripubertal rats

BackgroundConvulsive status epilepticus (CSE) prevention is critical for pediatric patients with epilepsy. Immediate intervention before CSE reduce severity. Despite its wide usage as an anticonvulsant, valproic acid (VPA) results in harmful side effects such as dose-dependent hepatotoxicity. Hence, reducing VPA dosage to minimize side effects while maintaining its efficacy is necessary, and transcranial photobiomodulation (tPBM) add-on therapy could facilitate this. We recently demonstrated for the first time that tPBM at a wavelength of 808 nm attenuated CSE in peripubertal rats. However, the effects of VPA with the add-on therapy of tPBM prior to seizures have not yet been explored. This study investigated whether adding tPBM to VPA exerts synergistic effect for CSE prevention in peripubertal rats.MethodsA gallium-aluminum-arsenide laser (wavelength of 808 nm with an exposure duration of 100 s and irradiance of 1.333 W/cm2 at the target) was applied transcranially 30 min after VPA injection in Sprague Dawley rats. All the rats received 90 mg/kg of pentylenetetrazole (PTZ). Except for the saline (n = 3), tPBM + saline (n = 3), and PTZ group (n = 6), all the rats received a PTZ injection 30 min after VPA injection. The rats received add-on tPBM with PTZ immediately after tPBM. In the VPA + PTZ group, the rats received low-dose (100 mg/kg, n = 6), medium-dose (200 mg/kg, n = 6), and high-dose (400 mg/kg, n = 7) VPA. In the VPA + tPBM + PTZ group, the rats received low (100 mg/kg, n = 5), medium (200 mg/kg, n = 6), and high (400 mg/kg, n = 3) doses of VPA. Seizures were evaluated according to the revised Racine’s scale in a non-blinded manner.ResultsAdding tPBM to low-dose VPA reduced the incidence of severe status epilepticus and significantly delayed the latency to stage 2 seizures. However, adding tPBM to high-dose VPA increased the maximum seizure stage, prolonged the duration of stage 4–7 seizures, and shortened the latency to stage 6 seizures.ConclusionsAdding tPBM to low-dose VPA exerted a synergistic prevention effect on PTZ-induced seizures, whereas adding tPBM to high-dose VPA offset the attenuation effect.

Neonatal Seizure Management: Is the Timing of Treatment Critical?

ObjectiveTo assess the impact of the time to treatment of the first electrographic seizure on subsequent seizure burden and describe overall seizure management in a large neonatal cohort.Study designNewborns (36-44 weeks of gestation) requiring electroencephalographic (EEG) monitoring recruited to 2 multicenter European studies were included. Infants who received antiseizure medication exclusively after electrographic seizure onset were grouped based on the time to treatment of the first seizure: antiseizure medication within 1 hour, between 1 and 2 hours, and after 2 hours. Outcomes measured were seizure burden, maximum seizure burden, status epilepticus, number of seizures, and antiseizure medication dose over the first 24 hours after seizure onset.ResultsOut of 472 newborns recruited, 154 (32.6%) had confirmed electrographic seizures. Sixty-nine infants received antiseizure medication exclusively after the onset of electrographic seizure, including 21 infants within 1 hour of seizure onset, 15 between 1 and 2 hours after seizure onset, and 33 at >2 hours after seizure onset. Significantly lower seizure burden and fewer seizures were noted in the infants treated with antiseizure medication within 1 hour of seizure onset (P = .029 and .035, respectively). Overall, 258 of 472 infants (54.7%) received antiseizure medication during the study period, of whom 40 without electrographic seizures received treatment exclusively during EEG monitoring and 11 with electrographic seizures received no treatment.ConclusionsTreatment of neonatal seizures may be time-critical, but more research is needed to confirm this. Improvements in neonatal seizure diagnosis and treatment are also needed.

Relationship Between Anesthesia Depth and Quality of Seizures in Patients Undergoing Electroconvulsive Therapy: A Prospective Observational Study.

Electroconvulsive therapy under general anesthesia is an established treatment for mood disorders, such as therapy-resistant depression. As most anesthetic drugs used for induction of anesthesia increase the seizure threshold, adequate depth of anesthesia without diminishing the therapeutic efficacy of interventions is crucial. The aim of this study was to investigate whether anesthesia depth as assessed by Narcotrend (NCT) monitoring correlates with maximum seizure quality. An observational study was performed in psychiatric patients undergoing multiple interventions of electroconvulsive therapy. Seizure quality of each attendance was assessed evaluating electroencephalogram end point, electromyogram end point, postictal suppression index, the midictal amplitude, and a 3-step overall graduation. Narcotrend was used to assess anesthesia depth according to index-based electroencephalogram findings. Measurements were obtained before induction of anesthesia, before stimulation, and after arousal. Data were analyzed by means of linear mixed models and generalized estimating equations models. A total of 105 interventions in 12 patients were analyzed. Anesthesia depth before stimulation was significantly associated with seizure quality (standardized β = 0.244, P = 0.010), maximum sustained coherence (β = 0.207, P = 0.022), and electroencephalogram duration (β = 0.215, P = 0.012). A cutoff value of 41 or greater versus 40 or less for the NCT index was found appropriate to differentiate between good and less satisfactory overall seizure quality. Anesthesia depth index assessed by NCT monitoring was positively associated with seizure quality. Narcotrend monitoring may be useful in assessment of optimal anesthesia depth before stimulation.

Abstract P235: Reduced Uterine Perfusion Pressure Impairs Seizure-induced Downregulation Of Neurotransmitter Transporters In Mice

Preeclampsia, a hypertensive disorder of pregnancy, can advance to eclampsia, if new onsetseizures occur. Previous work showed increased susceptibility to chemically-induced seizures inthe reduced uterine perfusion pressure (RUPP) rat model of preeclampsia; however, theunderlying mechanisms are unknown. Because seizures occur due to neurotransmitter activityimbalance, we hypothesized that RUPP mice have elevated excitatory and reduced inhibitoryactivity and that seizures exacerbate this imbalance.Timed-pregnant SMA-GFP mice (n=5-6 per group/treatment) were subjected to sham or RUPPsurgery on gestational day (GD) 13.5 and seizures were induced using 40mg/kg pentylenetetrazolon GD18.5. Tissues were harvested 30 minutes post-seizure induction. Maximum seizure scoreswere similar in sham (4.7±0.3) and RUPP (4.5±0.3) mice; p=0.37. Fluorometric assay showsseizures increased [F (1, 16) = 5.99, p=0.03], while RUPP had no effect [F (1, 16) = 1.15, p=0.3]on hippocampal glutamate concentration. No pairwise differences were observed within the shamand RUPP groups exposed to seizures (p&gt;0.05). Seizures increased [F (1, 16) = 6.96, p=0.02],while RUPP had no effect [F (1, 16) = 0.61, p=0.45] on GABA concentration, with no significantpairwise difference in GABA concentration (p&gt;0.05).Western blot analysis shows seizures significantly reduced hippocampal NMDAR1 (1.0±0.5 vs0.6±0.96, p=0.02; 1.0±0.1 vs 0.6±0.0, p=0.04) and GABAAR receptor expression (1.0±0.4 vs0.35±0.1, p&lt;0.5; 1.05±0.3 vs 0.3±0.1, p&lt;0.05) in sham and RUPP mice. Following seizureexposure, vesicular glutamate transporter (VGLUT1: sham: 1.0±0.3 vs 0.5±0.1; p&lt;0.01, RUPP:0.8±0.2 vs 0.6±0.1; p=0.11), excitatory amino acid transporter 1 (EAAT1: sham: 1.0±0.4 vs0.6±0.2; p=0.02, RUPP: 0.9±0.1 vs 0.6±0.2; p=0.17) and GABA transporter (GAT1: sham: 1.0±0.5vs 0.4±0.1, p=0.01; RUPP: 0.8±0.2 vs 0.5±0.1, p=0.12) was reduced in sham mice, but not RUPPmice.Although RUPP does not change baseline GABA or glutamate related receptor or transporterexpression, our findings suggest seizure-induced reductions in vesicular and astrocyticneurotransmitter transporters is impaired by the RUPP procedure. Ongoing studies assesswhether other receptors and transporters are affected.

Acid Sensing Ion Channel 2a Is Reduced in the Reduced Uterine Perfusion Pressure Mouse Model and Increases Seizure Susceptibility in Pregnant Mice.

Eclampsia is diagnosed in pregnant women who develop novel seizures. Our laboratory showed that the reduced uterine perfusion pressure (RUPP) rat model of preeclampsia displays reduced latency to drug-induced seizures. While acid sensing ion channels (ASIC1a and 3) are important for reducing seizure longevity and severity, the role of ASIC2a in mediating seizure sensitivity in pregnancy has not been investigated. We hypothesized that 1) RUPP reduces hippocampal ASIC2a, and 2) pregnant mice with reduced ASIC2a (ASIC2a+/−) have increased seizure sensitivity. On gestational day 18.5, hippocampi from sham and RUPP C57BL/6 mice were harvested, and ASIC2a was assessed using Western blot. Pregnant wild-type and ASIC2a+/− mice received 40 mg/kg of pentylenetetrazol (i.p.) and were video recorded for 30 min. Behaviors were scored using a modified Racine scale (0–7: 0 = no seizure; 7 = respiratory arrest/death). Seizure severity was classified as mild (score = 1–3) or severe (score = 4–7). RUPP mice had reduced hippocampal and placental ASIC2a protein. ASIC2a+/− mice had reduced latency to seizures, increased seizure duration, increased severe seizure duration, and higher maximum seizure scores. Reduced hippocampal ASIC2a in RUPP mice and increased seizure activity in pregnant ASIC2a+/− mice support the hypothesis that reduced ASIC2a increases seizure sensitivity associated with the RUPP.

Placental Ischemia increases Seizure Susceptibility through Reduced ASIC2a Expression

Introduction Eclampsia is diagnosed in pregnant women and women with preeclampsia, a hypertensive pregnancy disorder, who experience new-onset seizures. Previous studies from our laboratory showed that the rat model of preeclampsia, induced by reducing uterine perfusion pressure (RUPP), displays reduced latency to drug-induced seizures. The factors that contribute to increased seizure sensitivity in pregnancy and preeclampsia are unknown. While acid sensing ion channels (ASIC1a and 3) were shown to be important for reducing seizure longevity and severity, the role of ASIC2a in seizures during pregnancy or RUPP has not been investigated. Thus, we hypothesized that RUPP in mice reduces seizure latency and hippocampal ASIC2a expression. We further hypothesize that mice with reduced ASIC2a (ASIC2a+/-) will display increased seizure severity and duration. Methods Hippocampi from 5 RUPP and 6 Sham C57BL/6 pregnant mice were harvested on gestational day 18.5 and processed for Western blot analysis to assess ASIC2a expression. Seizures were induced using pentylenetetrazol (40 mg/kg, i.p) in RUPP and sham mice (n=5 per group), as well as pregnant wild type (WT) and ASIC2a heterozygous (HET) mice (n=7 or 14 per genotype) and video recorded for 30 minutes. Seizure behavior was scored using a modified Racine scale ranging from 0-7 (0 = no seizure, 7 = respiratory arrest). Seizure severity was separated into two generalized behaviors: petite-mal (1-3), grand-mal (4-7). Data are shown as Mean ± SEM. Results RUPP mice show a trend for reduced latency to seizure activity (63.4 ± 21.3 vs 103.3 ± 5.6s; p=0.068) and had a significant reduction in hippocampal ASIC2a expression (0.5 ± 0.1 in RUPP vs 1 ± 0.2 in Sham; p=0.037). ASIC2a HET mice displayed reduced latency to seizure activity (101 ± 18 vs 248 ± 85s, p=0.033), increased seizure duration (1253 ± 467s vs 823 ± 137s; p=0.019), decreased seizure-free duration (552 ± 125s vs 950 ± 145s; p=0.023), increased grand-mal seizure duration (713 ± 188 vs 18 ± 13s; p=0.004), and higher maximum seizure scores (WT= 3 ± 0; HET= 5 ± 1, p=0.011). ASIC2a HET mice display seizure behavior suggesting increased seizure susceptibility. Conclusion Our findings of reduced hippocampal ASIC2a expression in RUPP mice and increased seizure severity and longevity in pregnant mice with reduced ASIC2a, support the hypothesis that reduced ASIC2a increases seizure sensitivity in the context of placental ischemia.

LMR-101, a novel derivative of propofol, exhibits potent anticonvulsant effects and possibly interacts with a novel target on γ-aminobutyric acid type A receptors.

LMR-101 is a bisphenol derivative of propofol, a short-acting general anesthetic, which is also used to manage status epilepticus (SE). We evaluated the sedative and anticonvulsant effects of LMR-101 to discover its potential to manage epilepsy and SE in the clinic. Comparative studies between LMR-101 and propofol were performed in mice to elucidate an appropriate dose range for LMR-101 that produced anticonvulsant effects without significant sedation. Then, the anticonvulsive efficacy for LMR-101 was evaluated using seizure models induced by pentylenetetrazol and (+)-bicuculline. The ability of LMR-101 to inhibit SE was assessed using a rat model of SE induced by pilocarpine. Radioligand binding assay profiles for LMR-101 were performed to evaluate the potential mechanisms of action underlying its anticonvulsant properties. In the mouse study, LMR-101 exhibited greater anticonvulsant and lesser sedative effect compared with propofol. LMR-101 completely inhibited pentylenetetrazol-induced seizures at a dose of 50 mg/kg and exhibited heavy sedation at 300mg/kg. Propofol anesthetized all mice and only decreased the seizure rate at 25mg/kg. LMR-101 also suppressed seizure behaviors evoked by (+)-bicuculline in mice in a dose-dependent manner. In the pilocarpine-induced SE model, LMR-101 significantly decreased the maximum seizure score and seizure duration in a dose-dependent manner. The median effective dose for LMR-101 was 14.30mg/kg and 121.87mg/kg to prevent and inhibit sustained SE, respectively. In binding assays, LMR-101 primarily inhibited tert-[35 S] butylbicyclophosphorothionate binding to γ-aminobutyric acid type A (GABAA ) receptors (half-maximal inhibitory concentration = 2.06μmol·L-1 ), but it did not affect [3 H] flunitrazepam or [3 H] muscimol binding. It is anticipated that LMR-101 might play an essential role in the clinical management of epilepsy and SE. LMR-101 also might bind to a novel target site on the GABAA receptor that is different from existing antiepileptic drugs. Further study of the mechanisms of action of LMR-101 would be of considerable value in the search for new active drug sites on GABAA receptors.

On the Digital Psychopharmacology of Valproic Acid in Mice.

Antiepileptic drugs (AEDs) require daily ingestion for maximal seizure prophylaxis. Adverse psychiatric consequences of AEDs present as: (i) reversible changes in mood, anxiety, anger and/or irritability that often necessitate drug discontinuation, and (ii) autism and/or cognitive/psychomotor delays following fetal exposure. Technical advances in quantifying naturalistic rodent behaviors may provide sensitive preclinical estimates of AED psychiatric tolerability and neuropsychiatric teratogenicity. In this study, we applied instrumented home-cage monitoring to assess how valproic acid (VPA, dissolved in sweetened drinking water) alters home-cage behavior in adult C57BL/6J mice and in the adult offspring of VPA-exposed breeder pairs. Through a pup open field assay, we also examined how prenatal VPA exposure impacts early spontaneous exploratory behavior. At 500–600 mg/kg/d, chronic VPA produced hyperphagia and increased wheel-running without impacting sleep, activity and measures of risk aversion. When applied to breeder pairs of mice throughout gestation, VPA prolonged the latency to viable litters without affecting litter size. Two-weeks old VPA-exposed pups displayed open field hypoactivity without alterations in thigmotaxis. As adults, prenatal VPA-exposed mice displayed active state fragmentation, hypophagia and increased wheel running, together with subtle alterations in home-cage dyadic behavior. Together, these data illustrate how automated home-cage assessments of spontaneous behavior capture an ethologically centered psychopharmacological profile of enterally administered VPA that is aligned with human clinical experience. By characterizing the effects of pangestational VPA exposure, we discover novel murine expressions of pervasive neurodevelopment. Incorporating such rigorous assessments of psychological tolerability may inform the design of future AEDs with improved neuropsychiatric safety profiles, both for patients and their offspring.

Ameliorating Effects of Dorema ammoniacum on PTZ-Induced Seizures and Epileptiform Brain Activity in Rats.

The objective of the current study was to investigate the anti-epileptogenic and anticonvulsant effects of Dorema ammoniacum gum, which is used in Iranian traditional medicine for the treatment of seizures. Animals received pentylenetetrazol (IP, 30 mg/kg/48 h) for inducing seizures. Five different seizure stages were evaluated for 20 min and parameters including maximum seizure stage, the latency to the onset of stage 4, stage 4 duration, and seizure duration were measured. D. ammoniacum (50 and 100 mg/kg) or its vehicle was administered 30 min before or after pentylenetetrazol injection in different groups. In addition, the effective dose of D. ammoniacum (100 mg/kg) on different seizure stages was compared with the common antiseizure drug phenobarbital. In another set of experiments, we investigated the effective dose of D. ammoniacum on fully kindled animals in which an interictal electroencephalogram was recorded by superficial electrodes placed on the skull. The results showed that D. ammoniacum administration, before and after pentylenetetrazol injections, significantly decreased seizure stage, seizure duration, stage 4 duration, and 1/stage 4 latency. The anti-epileptogenic effect of D. ammoniacum was about 50 to 60% of phenobarbital. In addition, D. ammoniacum significantly decreased seizure stage, seizure duration, stage 4 duration, and 1/stage 4 latency when administered to fully kindled animals but had no effect on the power of EEG sub-bands. These results indicate that D. ammoniacum has anti-epileptogenic and anticonvulsant effects in a chemical kindling model of seizures.