Quinine, a blocker of neuronal cx36 channels, suppresses seizure activity in rat neocortex in vivo

PURPOSE: The selective contribution of neuronal gap junction (GJ) communication via connexin 36 (Cx36) channels to epileptogenesis and to the maintenance and propagation of seizures was investigated in both the primary focus and the mirror focus by using pharmacologic approaches with the 4-aminopyridine in vivo epilepsy model. METHODS: ECoG recording was performed on anesthetized adult rats, in which either quinine, a selective blocker of Cx36, or the broad-spectrum GJ blockers carbenoxolone and octanol were applied locally, before the induction or at already active epileptic foci. RESULTS: The blockade of Cx36 channels by quinine before the induction of epileptiform activity slightly reduced the epileptogenesis. When quinine was applied after 25-30 repetitions of seizures, a new discharge pattern appeared with frequencies >15 Hz at the initiation of seizures. In spite of the increased number of seizures, the summated ictal activity decreased, because of the significant reduction in the duration of the seizures. The amplitudes of the seizure discharges of all the patterns decreased, with the exception of those with frequencies of 11-12 Hz. The blockade of Cx36 channels and the global blockade of the GJ channels resulted in qualitatively different modifications in ictogenesis. CONCLUSIONS: The blockade of Cx36 channels at the already active epileptic focus has an anticonvulsive effect and modifies the manifestation of the 1- to 18-Hz seizure discharges. Our findings indicate that the GJ communication via Cx36 channels is differently involved in the synchronization of the activities of the networks generating seizure discharges with different frequencies. Additionally, we conclude that both neuronal and glial GJ communication contribute to the manifestation and propagation of seizures in the adult rat neocortex.     

A Contribution to the Genetics of Febrile Seizures: Waking and Sleep EEG in Siblings

Waking and sleep EEGs were recorded in 67 siblings of 52 patients with febrile seizures (FS). Epileptic activity was noted in at least 1 sibling for 28 of the 52 patients (53.8%). Epileptic discharges were noted in 33 (49.2%) of the 67 siblings. Thirty-two siblings had 3-4 Hz spike wave complexes, and 1 sibling had independent centrotemporal spike foci (rolandic foci). Epileptic activity was noted exclusively in the waking state in only 3%, in waking and sleep in 31.3%, and only in sleep in 14.9%. The greatest number of epileptic discharges occurred in waking during hyperventatilation (32.8%) and during stage C sleep (38.8%). In 5 photosensitive siblings, additional epileptic discharges were noted in sleep in 1 and in waking and sleep in 4. At least 1 sibling in 5 (55.6%) of 9 patients with complicated febrile seizures, in 23 (53.5%) of 43 patients with simple FS, and in 4 of 9 patients (44.4%) with later onset epileptic seizures had seizure discharges. At least 1 sibling in 24 of 43 patients (55.8%) with exclusively FS in 13 of 30 (43.3%) male patients and in 15 of 22 (68.2%) female patients had seizure discharges. Siblings aged 6-10 years had (66.7%) the highest rates of activation. Epileptic discharges were noted in 83.3% of siblings with seizures, but in only 45.9% of siblings without seizures. Seizure activity was recorded in 68.2% of siblings who had occipital 3-4-Hz theta-delta-activity but in only 13.0% of siblings without this pattern.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ictal SPECT in supplementary motor area seizures

OBJECTIVES: We used ictal single photon emission computed tomography (SPECT) to clarify the propagation pathways of epileptic discharges in patients with supplementary motor area (SMA) seizure. METHODS: In four patients (four males, age range, 18-27 years) with SMA seizures, SPECT studies by radioisotope 99mTc-ECD were performed as a preoperative evaluation. Two of the patients remained seizure-free after complete resection of the focal cortical dysplasia on magnetic resonance (MR) images including epileptic foci. In the other two patients, MR images were normal, but subdural electrode monitoring allowed for verifying the ictal onset in the left SMA. After partial resection of the SMA including epileptic foci, these patients experienced a significant (>90%) reduction of seizure frequency. Regional cerebral blood flow (rCBF) measurements obtained under ictal and interictal conditions were compared on a voxel-by-voxel basis by means of the SPM99 paired t-test option (uncorrected p<0.001). RESULTS: Significant increases in rCBF under ictal conditions were identified in the bilateral anterior cingulate cortex (ACC), the globus pallidus ipsilateral to epileptic foci and the contralateral cerebellar hemisphere. The right ACC included a cluster with a submaximum in the right primary sensorimotor area. DISCUSSION: In patients with SMA seizures, the hyperperfusion areas of ictal SPECT did not localize within the SMA but spread to the adjacent cortex such as the ACC and sensorimotor cortex ipsilateral to epileptic foci. Additionally, the epileptic discharges propagated to the remote areas such as the globus pallidus and cerebellum. We caution that ictal SPECT localization in patients with SMA seizures is not always concordant to epileptic focus but reveals already spread seizure activities.     

Gap junction gene expression in human seizure disorder.

Increased intercellular coupling has been implicated in contributing to the synchronization of discharges characteristic of epileptic foci. Using RNA blot analysis, the level of mRNA for the heart-type gap junction protein, connexin43, is shown to be elevated in samples of temporal lobe neocortex obtained at the time of surgical resection for intractable seizure disorder. Much lower levels of this mRNA are detectable in peritumoral temporal lobe tissue samples obtained during removal of cerebral tumors. However, in cases where the tumors had induced acute seizures, the level of connexin43 mRNA is higher than that detected in epileptic samples. Similar changes are observed for the mRNA for the liver-type gap junction protein, connexin32, although the observed differences are less dramatic. These findings indicate that there is an increase in the level of connexin mRNA in the temporal cortex of patients exhibiting seizure disorders, suggesting an increase in the synthesis of gap junction protein that may lead to an increase in intercellular coupling.     

Intra-amygdala all-trans retinoic acid inhibits amygdala-kindled seizures in rats

Amygdala plays an important role in induction and control of limbic seizures. There is a network of gap junctional communications in basolateral amygdala (BLA) as well. We compared the effect of intra-BLA infusion of the typical gap junction (GJ) blocker carbenoxolone (CBX), with the effect of putative GJ blocker all-trans retinoic acid (ATRA), on the afterdischarge (AD) recorded from BLA in amygdala-kindled rats. Both CBX and ATRA showed a rapid anti-seizure effect. Conversely, intra-BLA infusion of the known GJ opener, trimethylamine (TMA), enhanced seizure susceptibility by prolonging the duration of AD and generalized behavioral seizures. ATRA administered intra-BLA prevented the proconvulsant effect of TMA. The reduction of gap junctional conductance might be involved in the observed anticonvulsant effect of ATRA.     

Prognosis of epilepsy withdrawn from antiepileptic drugs

Abstract Antiepileptic drugs (AED) were discontinued in 55 epileptics who had been free from seizures treated with AED, in accordance with the following criteria and procedures. (i) A reduction in AED commences when patients have been free from seizures for at least 2 years and epileptic discharges have also disappeared in repeated electroencephalogram (EEG) recordings during that period. (ii) AED are gradually reduced if no relapse is seen in clinical seizures and epileptic discharges in EEG. (iii) As a rule at least 2 years are required as the interval from the onset of a reduction to the withdrawal of AED. Forty-three patients were followed up by a questionnaire and/or by telephone and the follow-up period from the withdrawal of AED to the survey ranged from 0.9 to 8.8 years; in 38 patients (88.4%) the period was longer than 2 years. No relapse of seizures was found in any of the 43 patients. The severity of epilepsy judged by the total number and frequency of seizures, the presence of neuropsychiatric complications, the combination of different types of seizures, and the duration of epilepsy from the seizure onset to the last seizure appeared not to be risk factors for the recurrence of seizure. Normal EEG was, however, considered to be an important prerequisite for a good prognosis.     

The development of independent foci in epileptic patients

The electroencephalograms of 309 unselected epileptic patients were reexamined to ascertain the incidence of independent secondary discharges. In 41 patients (13%), a simple one-sided focus, without evidence of independent secondary discharges, was found (group 1); in 33 patients (11%), an epileptic focus with certain evidence of independent secondary discharges was found (group 2). These two groups were compared with respect to multiple variables (eg, seizure type, time course of the epileptic illness, site of foci, medication, neurological status), and significant differences between the two groups were obtained (eg, with respect to frequency of seizures, duration of seizures, number of anticonvulsive drugs being taken, and in other respects). Our findings are compared with earlier work, and it is concluded that they do not support the conventional models of secondary epileptogenesis.     

Ictal SPECT in supplementary motor area seizures

Abstract

Objectives: We used ictal single photon emission computed tomography (SPECT) to clarify the propagation pathways of epileptic discharges in patients with supplementary motor area (SMA) seizure.

Methods: In four patients (four males, age range, 18–27 years) with SMA seizures, SPECT studies by radioisotope 99mTc-ECD were performed as a preoperative evaluation. Two of the patients remained seizure-free after complete resection of the focal cortical dysplasia on magnetic resonance (MR) images including epileptic foci. In the other two patients, MR images were normal, but subdural electrode monitoring allowed for verifying the ictal onset in the left SMA. After partial resection of the SMA including epileptic foci, these patients experienced a significant (>90%) reduction of seizure frequency. Regional cerebral blood flow (rCBF) measurements obtained under ictal and interictal conditions were compared on a voxel-by-voxel basis by means of the SPM99 paired t-test option (uncorrected p<0.001).

Results: Significant increases in rCBF under ictal conditions were identified in the bilateral anterior cingulate cortex (ACC), the globus pallidus ipsilateral to epileptic foci and the contralateral cerebellar hemisphere. The right ACC included a cluster with a submaximum in the right primary sensorimotor area.

Discussion: In patients with SMA seizures, the hyperperfusion areas of ictal SPECT did not localize within the SMA but spread to the adjacent cortex such as the ACC and sensorimotor cortex ipsilateral to epileptic foci. Additionally, the epileptic discharges propagated to the remote areas such as the globus pallidus and cerebellum. We caution that ictal SPECT localization in patients with SMA seizures is not always concordant to epileptic focus but reveals already spread seizure activities.     

Functional contribution of specific brain areas to absence seizures: role of thalamic gap-junctional coupling

The synchronized discharges typical of seizures have a multifactorial origin at molecular, cellular and network levels. During recent years, the functional role of gap-junctional coupling has received increased attention as a mechanism that may participate in seizure generation. We have investigated the possible functional roles of thalamic and hippocampal gap-junctional communication (GJC) in the generation of spike-and-wave discharges in a rodent model of atypical absence seizures. Seizures in this model spread throughout limbic, thalamic and neocortical areas. Rats were chronically implanted with cannulae to deliver drugs or saline, and local field potentials recordings were performed using intracerebral electrodes positioned in distinct brain areas. Initially, the effects on synaptic transmission of the gap-junctional blockers used in this study were determined. Neither carbenoxolone (CBX) nor 18-alpha-glycyrrhetinic acid altered chemical synaptic transmission at the concentrations tested. These two compounds, when injected via cannulae into the reticular nucleus of the thalamus (NRT), decreased significantly the duration of seizures as compared with saline injections or injections of the CBX inactive derivative glycyrrhizic acid. CBX injections into the hippocampus resulted in diminished seizure activity as well. NRT injections of trimethylamine, which presumably causes intracellular alkalinization (thereby promoting gap-junctional opening), enhanced seizures and spindle activity. These observations suggest that, in this rodent model, thalamic and limbic areas are involved in the synchronous paroxysmal activity and that GJC contributes to the spike-and-wave discharges.     

PLED pattern and its clinical significance in stroke patients

The pathophysiological connection between periodic lateralized epileptiform discharges (PLED) and epileptic seizures is still not clear. In the study clinical data and EEG findings were analysed in 22 patients aged 43-90 years with a history of stroke in whom EEG disclosed PLED. Eleven patients were studied in the acute phase of stroke and 11 were studied years after stroke when the diagnosis was established of poststroke epilepsy. In 2 patients in acute stroke group single epileptic seizures occurred and 5 had partial status epilepticus. In the group with poststroke epilepsy 4 had single seizures and 4 had epileptic status with partial epilepsy seizures. Thus, in 15 out of 22 patients PLEDs were noted after epileptic seizures. In all cases PLED appearance was connected with consciousness disturbances, lasting 1 to 17 days. In 6 cases PLED pattern was interrupted by seizure activity over one hemisphere, in 3 of them partial epileptic seizures were associated with it. In acute phase of stroke neuroimaging demonstrated the presence of fresh ischaemic foci, but in cases of poststroke epilepsy no such fresh foci were observed. These results suggest that PLED frequently can be associated with epilepsy, and in some patients it can be a bioelectrical manifestation of partial status epileptic.     

Epileptics with EEG independent multifocal spike discharges (author's transl)

Retrospective data on 77 epileptic patients allowed the following conclusions: Epilepsies with EEG independent multifocal spike discharges are mainly observed in children. Partial unilateral or generalized seizures are encountered. No relationship exists between the EEG foci and the seizure pattern. Acquired cerebral lesions are common. Multifocal spike discharges are functional foci, appearing and disappearing without close correlation with the evolution of seizures. They are an age-dependent expression of a disease which extends far beyond the seizures. They have to be absolutely distinguished from stable epileptic foci found in multifocal epilepsies.     

Differential effects of trimethylamine and quinine on seizures induced by 4-aminopyridine administration in the entorhinal cortex of vigilant rats

In vivo and in vitro evidence from animals suggesting that gap junctions (GJs) play a role in the spreading of epileptiform activity. We have examined the influence of the gap junction opener trimethylamine (TMA) and the connexin 36 (Cx36) gap junctional blocker, quinine, on epileptiform activity induced by 4-aminopyridine (4-AP) in the rat entorhinal cortex (EC) and the CA1 hippocampal region. A cannula and surface electrodes were implanted into the brain to administer drugs and to monitor electrical activity. Injection of 4-AP (10 nmol) produced epileptiform discharge trains of high amplitude and frequency associated with seizure behavior rated between 0 and 3 in the Racine scale. In the presence of TMA (500 nmol), 4-AP produced distinct epileptiform patterns with continuous, long epileptiform discharges of high amplitude and frequency associated with seizure behavior of 0, 1, 3 and 5 during the first 30 min post-drug administration that diminished after 90 min. Quinine injection (35 pmol) into the EC of seizing animals decreased the amplitude and frequency of the discharge trains in the EC and CA1 regions, which were completely blocked after 34 min. Indeed, the seizure behavior of the animals was completely blocked in five of the six rats 53.2 s after quinine administration. We suggest that the intensity of the proepileptic effect of TMA on epileptiform activity depends on the time and route of drug administration, and that neural Cx36-dependent GJs are important structures in the generation of epileptiform activity, as well as in the seizure behavior induced by 4-AP.     

Effects of gap junction blockers on human neocortical synchronization

Field potentials and intracellular recordings were obtained from human neocortical slices to study the role of gap junctions (GJ) in neuronal network synchronization. First, we examined the effects of GJ blockers (i.e., carbenoxolone, octanol, quinine, and quinidine) on the spontaneous synchronous events (duration = 0.2-1.1 s; intervals of occurrence = 3-27 s) generated by neocortical slices obtained from temporal lobe epileptic patients during application of 4-aminopyridine (4AP, 50 muM) and glutamatergic receptor antagonists. The synchronicity of these potentials (recorded at distances up to 5 mm) was decreased by GJ blockers within 20 min of application, while prolonged GJ blockers treatment at higher doses made them disappear with different time courses. Second, we found that slices from patients with focal cortical dysplasia (FCD) could generate in normal medium spontaneous synchronous discharges (duration = 0.4-8 s; intervals of occurrence = 0.5-90 s) that were (i) abolished by NMDA receptor antagonists and (ii) slowed down by carbenoxolone. Finally, octanol or carbenoxolone blocked 4AP-induced ictal-like discharges (duration = up to 35 s) in FCD slices. These data indicate that GJ play a role in synchronizing human neocortical networks and may implement epileptiform activity in FCD.     

Long-term follow-up study of Lennox-Gastaut syndrome in patients with severe motor and intellectual disabilities: with special reference to the problem of dysphagia.

A long-term follow-up study of Lennox-Gastaut syndrome (LGS) ( > 10 years) was conducted with 38 patients with severe motor and intellectual disabilities (SMID) to clarify the relationship between the rapid development of dysphagia and epileptic seizures, and to elucidate the long-term evolution of LGS in patients with SMID. Those who showed a relatively favourable seizure outcome were compared to those with a poor seizure outcome. Poor seizure outcome correlated strongly with: (a) an early appearance of dysphagia and additional deterioration of the already retarded mental function; (b) a predominance of atypical absence seizures; and (c) persistent frequent epileptiform discharges during electroencephalographic evaluations. Neither age at seizure onset nor intelligence level at the time of the last examination was correlated with seizure prognosis. Further, seizure prognosis was not related to the aetiology of LGS. Repeated seizures apparently caused development of progressive epileptic encephalopathy, in addition to the underlying severe brain damage. Since development of dysphagia burdens an already severely handicapped patient with intensive medical care, efforts to reduce the seizures and design a long-term care plan are of great importance.     

连接蛋白拟似肽对海人酸致痫大鼠脑电活动的影响

目的观察针对连接蛋白43(CX43)合成的特异性的缝隙连接阻断剂-连接蛋白拟似肽对海人酸致痫大鼠脑电活动的影响。方法建立18只大鼠癫痫动物模型,分连接蛋白拟似肽组、甘珀酸组和对照组(每组6只),在在体上分别局部给予连接蛋白似似肽、甘珀酸和生理盐水,用脑电图仪观测用药前后每组大鼠皮层脑电活动的变化情况。结果连接蛋白拟似肽组及甘珀酸组给药后癫痫的发作次数明显比给药前发作次数减少,癫痫波的平均振幅也明显变小,给药前后比较有显著性差异(P<0.01),生理盐水组给药前后癫痫的发作次数及平均振幅几乎没有变化。连接蛋白拟似肽组给药前后癫痫的发作次数和波幅的变化值与甘珀酸组给药前后癫痫的发作次数和波幅的变化值相比无显著性差异。结论针对CX43合成的连接蛋白拟似肽可以特异性地抑制癫痫的发作。     

Ictal electroencephalographic findings of neonatal seizures in preterm infants

The aim of this study is to clarify the characteristics of ictal EEG findings of neonatal seizures in preterm infants. Seizures associated with ictal EEG changes were recognized in nine infants with gestational age of less than 37 weeks. Propagation, migration, shifting, changes in morphology of ictal EEG discharges were evaluated. Seizure manifestation was divided into the following categories; motor seizure, apneic seizure, automatic seizure and seizure without clinical symptoms. The types of the seizures were motor seizures in five infants, apneic in two, automatic in one and those without clinical symptoms in five. All seizures were of focal onset. The foci of seizures were temporal in six infants, occipital in two, central in one, and frontal in one. The morphology of ictal discharges was low voltage spikes or sharp waves in six infants, spikes in two, theta waves in one and high-voltage spiky theta in one. The propagation of ictal discharges was focal in five infants and regional in five. The migration of ictal discharges was observed in two infants and a shift in two. There was no clear relation between seizure manifestation and ictal EEG foci, duration of seizures and morphology or propagation of ictal discharges.     

颞叶癫痫患者脑中连接蛋白32表达变化及其意义

目的研究连接蛋白32在颞叶癫痫患者病变海马组织中的表达,从而为癫痫的发病机制进一步提供理论依据。方法14例颞叶癫痫（伴海马硬化）患者手术切除的病变海马组织为癫痫组,8例因其他疾病死亡进行尸检者的正常海马组织为对照组,死者生前无癫痫发作,利用免疫组织化学与蛋白印迹检测（Western-blot）方法检测两组连接蛋白32的表达水平,并进行比较。结果应用免疫组织化学方法检测发现对照组连接蛋白32有比较低的水平表达,但在癫痫患者的海马组织中表达增强,差异有显著性（P〈0．01）;应用Western-blot方法检测发现对照组连接蛋白32有低水平表达,在癫痫患者的海马组织中表达明显增强,差异有非常显著性（P〈0．001）。结论颢叶癫痫患者海马组织中连接蛋白32表达增高,缝隙连接在癫痫的发生、发展过程中可能起到了重要作用。     

Astrocytic gap junction removal,connexin43 redistribution,and epitope masking at excitatory amino acid lesion sites in rat brain

We previously reported that kainic acid (KA) lesion sites in rat brain exhibit an absence of astrocytic gap junctions at 1 week post-lesion. Loss of immunocytochemical reactivity with a sequence-specific antibody against the astrocytic gap junctional protein connexin43 (Cx43) suggested epitope masking since persistence of Cx43 was observed on Western blots. Here we determined the fate of Cx43 at various times after thalamic KA and straital NMDA lesions. In normal tissue and at 6 hr post-KA lesion, Cx43 immunoreactivity predominated at typical astrocytic gap junctions. Immunolabelled junctions were still seen at 3 days, with epitope masking already present, and were virtually absent by 6 days post-lesion. Gap junction remodeling was indicated by the appearance of intercellular immunostained annular profiles and uncharacteristically extensive gap junctions between symmetrically immunolabelled membranes and between labelled astrocytic and unlabelled oligodendrocytic membranes. Labelled multivesicular clusters emerged at 2 days, were numerous at 3 days and constituted the sole Cx43 sequestration site by post-lesion day 6. Ultrastructural disruption and gap junction disassembly progressed more slowly in NDMA-injected tissue where immunoreactivity persisted, albeit at markedly decreasing levels until the final survival time examined (16 days). Intense Cx43 immunolabelling was seen in filopodia of putative reactive astrocytes at the lesion periphery at 6–8 days and was associated at 16 days with an increased number of gap junctions primarily between fine astrocytic processes. These results demonstrate that massive neuronal loss alone or in conjunction with direct actions of excitotoxins on astrocytes precipitates an astrocytic reaction accompanied initially by removal of their gap junctions followed by redistribution of Cx43, and suggest that the astrocytic syncytium may undergo reorganization in a manner leading to isolation of the lesion site. © 1995 Wiley-Liss, Inc.     

Inhibition of astroglial connexin43 hemichannels with TAT‐Gap19 exerts anticonvulsant effects in rodents

Accumulating evidence shows a key function for astrocytic connexin43 (Cx43) signaling in epilepsy. However, the lack of experimental distinction between Cx43 gap junction channels (GJCs) and hemichannels (HCs) has impeded the identification of the exact contribution of either channel configurations to epilepsy. We therefore investigated whether TAT‐Gap19, a Cx mimetic peptide that inhibits Cx43 HCs but not the corresponding Cx43 GJCs, influences experimentally induced seizures in rodents. Dye uptake experiments in acute hippocampal slices of mice demonstrated that astroglial Cx43 HCs open in response to the chemoconvulsant pilocarpine and this was inhibited by TAT‐Gap19. In vivo, pilocarpine‐induced seizures as well as the accompanying increase in D‐serine microdialysate levels were suppressed by Cx43 HC inhibition. Moreover, the anticonvulsant action of TAT‐Gap19 was reversed by exogenous D‐serine administration, suggesting that Cx43 HC inhibition protects against seizures by lowering extracellular D‐serine levels. The anticonvulsive properties of Cx43 HC inhibition were further confirmed in electrical seizure mouse models, i.e. an acute 6 Hertz (Hz) model of refractory seizures and a chronic 6 Hz corneal kindling model. Collectively, these results indicate that Cx43 HCs play a role in seizures and underscore their potential as a novel and druggable target in epilepsy treatment.