Prolonged febrile seizures in the immature rat model enhance hippocampal excitability long term

Febrile seizures (FSs) constitute the most prevalent seizure type during childhood. Whether prolonged FSs alter limbic excitability, leading to spontaneous seizures (temporal lobe epilepsy) during adulthood, has been controversial. Recent data indicate that, in the immature rat model, prolonged FSs induce transient structural changes of some hippocampal pyramidal neurons and long-term functional changes of hippocampal circuitry. However, whether these neuroanatomical and electrophysiological changes promote hippocampal excitability and lead to epilepsy has remained unknown. By using in vivo and in vitro approaches, we determined that prolonged hyperthermia-induced seizures in immature rats caused long-term enhanced susceptibility to limbic convulsants that lasted to adulthood. Thus, extensive hippocampal electroencephalographic and behavioral monitoring failed to demonstrate spontaneous seizures in adult rats that had experienced hyperthermic seizures during infancy. However, 100% of animals developed hippocampal seizures after systemic administration of a low dose of kainate, and most progressed to status epilepticus. Conversely, a minority of normothermic and hyperthermic controls had (brief) seizures, none developing status epilepticus. In vitro, spontaneous epileptiform discharges were not observed in hippocampal-entorhinal cortex slices derived from either control or experimental groups. However, Schaeffer collateral stimulation induced prolonged, self-sustaining, status epilepticus-like discharges exclusively in slices from experimental rats. These data indicate that hyperthermic seizures in the immature rat model of FSs do not cause spontaneous limbic seizures during adulthood. However, they reduce thresholds to chemical convulsants in vivo and electrical stimulation in vitro, indicating persistent enhancement of limbic excitability that may facilitate the development of epilepsy.     

Maturational changes in postictal refractoriness and seizure susceptibility in developing rats

The ability of the central nervous system to suppress recurrent seizures as a function of age was determined in rats. Eight electrical stimulations were delivered to the amygdala at 2-minute intervals in adult and suckling rats that were previously kindled from the left amygdala. During this 16-minute period, prolonged and severe convulsions were repeatedly elicited in the 16-day-old rat pups, whereas convulsions were not always elicited in adul rats. The results suggest that immature rats are more prone to develop status epilepticus than adult rats. Subsequently, the rat pus and implanted but not stimulated littermates were allowed to grow. At maturity, all the surviving animals were kindled from the contralateral (right) amygdala. The previously kindled rats developed seizures significantly faster than did their littermates. However, their respective abilities to suppress recurrent seizures did not differ at 150 and 210 days of age, being similar to the seizure suppression abilities of naive controls and significantly greater than those evidenced in infancy. We conclude that the propensity to develop single seizures in adulthood is directly related to infant seizure history, whereas the ability to suppress multiple seizures is a dynamic process that is modified by age, being minimal early in life and enhanced with maturation independently of history of infantile convulsions.     

Effects of neonatal seizures on subsequent seizure-induced brain injury

BACKGROUND: Although seizures are very common in neonates and are often the harbinger of poor neurologic outcome, there is controversy regarding the degree of brain damage induced by seizures during early development. Here, we evaluated the effect of neonatal seizures on subsequent brain injury induced by status epilepticus. METHODS: Twenty-five seizures were induced by the inhalant flurothyl in neonatal rats during the first 5 days of life. Flurothyl reliably produced generalized seizures with concomitant electroencephalographic changes and a low mortality rate. During adolescence or early adulthood, animals were subjected to status epilepticus using either kainic acid or perforant path stimulation. RESULTS: Although flurothyl-induced neonatal seizures did not cause cell death, animals that had neonatal seizures had significantly more severe brain injury after both kainic acid and perforant path stimulation than did animals without a history of neonatal seizures. CONCLUSIONS: Neonatal seizures increase the susceptibility of the developing brain to subsequent seizure-induced injury.     

Seizures in the developing brain cause adverse long-term effects on spatial learning and anxiety

PURPOSE: Seizures in the developing brain cause less macroscopic structural damage than do seizures in adulthood, but accumulating evidence shows that seizures early in life can be associated with persistent behavioral and cognitive impairments. We previously showed that long-term spatial memory in the eight-arm radial-arm maze was impaired in rats that experienced a single episode of kainic acid (KA)-induced status epilepticus during early development (postnatal days (P) 1-14). Here we extend those findings by using a set of behavioral paradigms that are sensitive to additional aspects of learning and behavior. METHODS: On P1, P7, P14, or P24, rats underwent status epilepticus induced by intraperitoneal injections of age-specific doses of KA. In adulthood (P90-P100), the behavioral performance of these rats was compared with that of control rats that did not receive KA. A modified version of the radial-arm maze was used to assess short-term spatial memory; the Morris water maze was used to evaluate long-term spatial memory and retrieval; and the elevated plus maze was used to determine anxiety. RESULTS: Compared with controls, rats with KA seizures at each tested age had impaired short-term spatial memory in the radial-arm maze (longer latency to criterion and more reference errors), deficient long-term spatial learning and retrieval in the water maze (longer escape latencies and memory for platform location), and a greater degree of anxiety in the elevated plus maze (greater time spent in open arms). CONCLUSIONS: These findings provide additional support for the concept that seizures early in life may be followed by life-long impairment of certain cognitive and behavioral functions. These results may have clinical implications, favoring early and aggressive control of seizures during development.     

Status epilepticus induced by lithium-pilocarpine in the immature rat does not change the long-term susceptibility to seizures

The causal relationship between early seizures and subsequent temporal lobe epilepsy has not yet been established. Prospective clinical studies reported that seizures occurring early in life rarely result in hippocampal sclerosis. Likewise, in most experimental models, early seizures occurring before the end of the second postnatal week do not lead to neuronal damage and subsequent epilepsy. In some models, this early event decreases latency sensitivity and threshold to seizures. In the present study, we induced lithium and pilocarpine status epilepticus (SE) in 10-day-old (P10) rats. The goal of this study was to determine whether this early life SE altered the sensitivity to convulsants such as pentylenetetrazol (20 and 25 mg/kg), picrotoxin (2.5 and 4.0 mg/kg) and kainate (5 and 8 mg/kg) during adulthood. The occurrence of electrographic seizures (spike-and-wave discharges, SWD) and/or of behavioral seizures was monitored. There was no difference in latency to and duration of SWDs and seizures between lithium-saline and lithium-pilocarpine exposed rats. Thus, SE induced by lithium and pilocarpine early in life does not change the sensitivity to limbic seizures or seizures induced by GABA(A) antagonists during adulthood.     

Ocular pain: a neurological perspective

Status epilepticus is common in infants and may have long-term consequences on the brain persisting into adulthood. Vascular ischemia is a common cause of stroke in adulthood. The extent of stroke in 15-day-old rats is larger when previously exposed to kainic acid-induced status epilepticus. In this paper, we assess whether shortening the duration of seizures modifies subsequent susceptibility to middle cerebral artery occlusion. We administered pentobarbital 50 mg/kg to abort seizures after 1 h. Although administration of pentobarbital aborted seizures, it had no effect on volume of infarction following ischemia. This study indicates that there is dissociation between stopping status epilepticus and modifying its long-term consequences.     

FOLLOW-UP STUDY OF 482 CASES WITH CONVULSIVE DISORDERS IN THE FIRST YEAR OF LIFE

A total of 482 patients who had had one or more seizures in the first year of life were followed for at least five years (most for more than 10 years). The patients were divided into four groups: febrile convulsions, infantile spasms, status epilepticus and 'other'. Of those with febrile convulsions, 62 per cent developed normally, compared with 14 per cent in the group with infantile spasms, 15 per cent with status epilepticus, and 24 per cent in the 'other' group. Findings on recurrent seizures, epilepsy and mental retardation and/or neurological abnormalities are also reported. Epilepsy developed equally frequently among those with partial and with generalised seizures, but the former more frequently became mentally retarded. The effects of severity of seizures and other factors are discussed. In general, this research confirmed the grave prognosis after seizures during the first year of life, and not only for West syndrome and status epilepticus. The outcome was more favourable when the seizures were cryptogenic or febrile, isolated, with onset in the second six months, generalised, and when the EEG was normal between seizures.     

Continuous infantile spasms as a form of status epilepticus

An infant with congenital cytomegalovirus infection first developed seizures at six weeks of age. At 3 1/2 months of age, he developed continuous infantile spasms that lasted for more than an hour. This episode of status epilepticus was terminated by intravenous lorazepam and paraldehyde, and seizures were subsequently controlled for seven months by adrenocorticotropic hormone (ACTH), valproic acid, and phenobarbital. This case demonstrates that continuous infantile spasms may occur as a unique form of status epilepticus in young infants.     

Status epilepticus facilitated by pilocarpine in amygdala-kindled rats

A novel model of status epilepticus based on the kindling model of epilepsy is described. The model involves the administration of a small dose of pilocarpine (20 mg/kg) to rats that have been previously kindled. Stimulation of these pretreated rats produces seizures which continue uninterrupted for approximately 4 h before spontaneous termination. The electroencephalographic discharge pattern showed characteristic changes in polarity and amplitude throughout the duration of status epilepticus. Behaviorally, the animals showed motor seizures which varied between stages I through IV, with evidence of extensive bilateral hemispheric involvement through much of the seizure episode. Animals that had been partially kindled to stage II seizures did not develop status epilepticus after stimulation when pretreated with pilocarpine, indicating that prior kindling is integral to the development of status epilepticus in this model. Administration of scopolamine was ineffective in terminating the condition when it had begun, suggesting that cholinergic stimulation is necessary for the initiation, but not the maintenance, of status epilepticus. This model holds promise for the study of status epilepticus because the condition develops in a seizure-prone (kindled) rat, and the seizures are self-sustaining, without the presence of exogenous chemicals or neurotoxins.     

Stimulation-induced status epilepticus: role of the hippocampal mossy fibers in the seizures and associated neuropathology

A study of seizure activity and neuronal cell death produced by intracerebroventricular kainic acid had suggested that seizures conveyed by the hippocampal mossy fibers are more damaging to CA3 pyramidal cells than seizures conveyed by other pathways. To test this idea, the effects of a unilateral mossy fiber lesion were determined on seizure activity and neuronal degeneration provoked by repetitive electrical stimulation of the hippocampal fimbria in unanesthetized rats. Fimbrial stimulation resulted in self-sustained status epilepticus accompanied by neuronal degeneration in several brain regions, including area CA3 of the hippocampal formation. A unilateral mossy fiber lesion more readily attenuated the electrographic and behavioral seizures provoked by fimbrial stimulation than those provoked by kainic acid. If status epilepticus developed in the presence of a mossy fiber lesion, denervated CA3 pyramidal cells were still destroyed, although similar lesions protect these neurons from kainic acid-induced status epilepticus. Thus the two models of status epilepticus employ somewhat different seizure circuitries and neurodegenerative mechanisms. Seizures which involve the mossy fiber projection are not necessarily more damaging to CA3 pyramidal cells than seizures which do not.     

Flurothyl status epilepticus in developing rats: behavioral, electrographic histological and electrophysiological studies.

Status epilepticus and repeated seizures have age-dependent morphological and neurophysiological alterations in the hippocampus. In the present study, effects of flurothyl-induced status epilepticus were examined in awake and free moving immature (2 weeks old) and adult rats. Without exception, adult rats died of respiratory arrest before the onset of status epilepticus. We were unable to find a concentration of flurothyl that produced status epilepticus and a low mortality in adult rats. In contrast, immature rats survived flurothyl status epilepticus for up to 60 min with a very low mortality. In rat pups, behavioral manifestations correlated with electrographic seizures in both the cortex and hippocampus. Neuropathological damage (cell loss, pyknotic cells or gliosis) was not observed in the immature hippocampus, thalamus, amygdala, substantia nigra or cortex at 24 h, 2 days or 2 weeks after status epilepticus. In addition, no aberrant mossy fiber reorganization or decrease in cells counts were observed in the hippocampus. Young rats did not show alterations in paired-pulse perforant path inhibition following flurothyl status epilepticus. The present findings are consistent with studies in other seizure models, indicating that immature rats are highly resistant to seizure-induced changes.     

Interstrain differences in cognitive functions in rats in relation to status epilepticus

Cognitive functions of Long Evans (N=30) and Wistar rats (N=32) were compared using a Morris water maze. Under control conditions the Long Evans rats were more efficient in this test, their average escape latency after 5 days of training (6.4+/-0.1 s, mean+/-S.E.M.) was significantly shorter than that of the Wistar rats (11.0+/-0.1 s). When the training was completed seizures were induced by an intraperitoneal injection of pilocarpine (330 mg/kg in the Long Evans strain and 350 mg/kg in the Wistar rats) 30 min after pretreatment with N-methylscopolamine (1 mg/kg i.p.). Clonazepam (1 mg/kg i.p.) was used to interrupt clonic seizures after 2 hours of continuous activity. Approximately one quarter of rats in both strains did not develop seizures. Severe convulsive status epilepticus was common in Long Evans rats (23 out of 30). In contrast, only 12 Wistar rats generated convulsive status epilepticus and the same number of animals exhibited only bursts of motor seizures separated by periods without convulsions (temporary seizures). Mortality after pilocarpine-induced status epilepticus was considerably higher in the Long Evans rats than in the Wistar rats. After a latency of 2-3 weeks spontaneous recurrent seizures appeared in all animals surviving status. Cognitive memory was tested during the 'silent period' between status and recurrent seizures. The Long Evans rats were unable to find the platform at the 3rd and 6th day after status but then their performance rapidly improved. The performance of the Wistar rats undergoing status epilepticus was seriously deteriorated and it never normalized, whereas the animals with temporary seizures exhibited only a transitory marginal prolongation of latencies. The hippocampal formation was damaged by status epilepticus in rats of both strains - the Long Evans rats exhibited more extensive damage of subfields CA1 and CA3, whereas in the Wistar rats a complete destruction of hilar neurons was observed in addition to partial CA1 and CA3 damage.     

Status epilepticus and brain maturation

The development of a limbic and a generalized tonic-clonic form of epilepsy, induced by systemic injections of kainic acid and pentylenetetrazol respectively, has been studied in developing rats. The purpose of this research was to investigate the correlations between the maturational stages of the CNS and the electro-clinical manifestations of epilepsy and status epilepticus. In both models of epilepsy, the electro-clinical patterns of seizures typical of the adult animal were reached as early as the third week of life. During the first weeks, atypical behavioural and EEG epileptic manifestations were observed. An attempt has been made to compare the experimental results with the electro-clinical epileptic signs of the infant, in order to suggest some neurophysiological explanations of the peculiar aspects of infantile epilepsy.     

Increased persistent sodium currents in rat entorhinal cortex layer V neurons in a post-status epilepticus model of temporal lobe epilepsy

PURPOSE: Spontaneous seizures in rats emerge several weeks after induction of status epilepticus with pharmacologic treatment or electrical stimulation, providing an animal model for human temporal lobe epilepsy. In this study, we investigated whether status epilepticus caused changes in the function of voltage-gated sodium channels in entorhinal cortex layer V neurons, a cellular group important for the genesis of limbic seizures. METHODS: We induced status epilepticus in rats, by using lithium-pilocarpine, and then 2-12 weeks later, used whole-cell voltage-clamp to examine voltage-activated sodium currents of acutely dissociated layer V neurons. RESULTS: Transient sodium currents of entorhinal cortex layer V neurons isolated from 9- to 12-week post-status epilepticus rats were similar to currents in age-matched controls; however, low-threshold persistent sodium currents were significantly larger. This increase in persistent activity was not seen 2-3 weeks after pilocarpine treatment; thus it occurred after a delay comparable to the delay in the appearance of spontaneous seizures. CONCLUSIONS: Increased persistent currents are expected to accentuate neuronal excitability and thus may contribute to the genesis of spontaneous seizures after status epilepticus.     

Limbic seizures without brain damage after injection of low doses of kainic acid into the amygdala of freely moving rats

Kainic acid (KA, 8-15 ng) was injected into the amygdala of conscious freely moving rats via chronically implanted fused silica cannulas. At 15-25 min after the injection, most rats suffered a limbic seizure attack of short duration, consisting of mastication, forelimb clonus, and raising on hind limbs, behaviorally indistinguishable from kindled seizures. Typically, the attack was followed by stereotypies, intense exploration, and by 1 or 2 more attacks. About 60 min after the injection, most rats appeared normal again and histopathological changes in their brains did not exceed those seen in vehicle-injected rats. In 3 cases, however, recurrent seizures culminated in behavioral status epilepticus 60-90 min after the injection. The status epilepticus was stopped by i.p. injection of diazepam (10 mg/kg) after a duration of 10 min (1 case) and 30 min (2 cases), respectively. After 10 min status epilepticus, we observed marginal neuronal damage with slight gliosis in both hippocampi (CA3 and CA1); after 30 min, hippocampal histopathology was more pronounced, with additional necrosis of the ipsilateral piriform cortex. After 0.8 microgram KA, a hundredfold higher dose, the incidence of limbic seizures during the first 40 min was not significantly higher (9/12) than after the lower KA doses (13/19). However, a significantly higher proportion of rats exhibited long-lasting seizure activity, associated with confluent destruction of CA3 pyramidal cells and additional seizure-related brain damage. Our results show that limbic motor seizures do not inevitably lead to histopathological changes in the brain, provided they do not culminate in a state of permanent seizure activity.     

Epilepsy after early-life seizures can be independent of hippocampal injury

Prolonged early-life seizures are considered potential risk factors for later epilepsy development, but mediators of this process remain largely unknown. Seizure-induced structural damage in hippocampus, including cell loss and mossy fiber sprouting, is thought to contribute to the hyperexcitability characterizing epilepsy, but a causative role has not been established. To determine whether early-life insults that lead to epilepsy result in similar structural changes, we subjected rat pups to lithium-pilocarpine-induced status epilepticus during postnatal development (day 20) and examined them as adults for the occurrence of spontaneous seizures and alterations in hippocampal morphology. Sixty-seven percent of rats developed spontaneous seizures after status epilepticus, yet only one third of these epileptic animals exhibited visible hippocampal cell loss or mossy fiber sprouting in dentate gyrus. Most epileptic rats had no apparent structural alterations in the hippocampus detectable using standard light microscopy methods (profile counts and Timm's staining). These results suggest that hippocampal cell loss and mossy fiber sprouting can occur after early-life status epilepticus but may not be necessary prerequisites for epileptogenesis in the developing brain.     

Transient loss of inhibition precedes spontaneous seizures after experimental status epilepticus

The pathophysiological mechanisms that cause spontaneous seizures following status epilepticus are largely unknown. Erosion of inhibition is regarded as an important pathophysiological hallmark of ongoing status epilepticus. Therefore, we investigated if loss of inhibitory functions also plays an important role in the development of spontaneous seizures after status epilepticus. Furthermore, we analyzed possible changes in excitation that might contribute to epileptogenesis. Finally, neuronal cell loss in the dentate gyrus granule cell layer was analyzed. In rats, inhibition and excitation in the dentate gyrus were monitored 1, 4, and 8 weeks after electrically induced self-sustaining status epilepticus (SSSE). Control animals had electrodes implanted either without subsequent stimulation or with stimulation but under barbiturate anesthesia, neither of which resulted in subsequent spontaneous seizures or impairment of inhibition. Following SSSE 80% of animals developed seizures after 8 weeks. A pronounced impairment of inhibition 1 week after SSSE was followed by gradual recovery over 8 weeks. In the dentate gyrus, cell damage was highly variable most likely explaining the heterogeneity of changes in excitatory parameters. Loss of GABAergic inhibition in the dentate gyrus may facilitate initiation of epileptogenesis but impaired inhibition is not required for the process of epileptogenesis to be maintained.     

Treatment of status epilepticus]

Status epilepticus (SE) is a condition requiring emergency care. There are convulsive SE, non-convulsive SE including complex partial status and absence status, non-convulsive electric SE and pseudostatus epilepticus, although convulsive SE is the most common. Diagnosis of status epilepticus of complex partial seizures (CPS) and absence seizures was significantly delayed because delays in seeking medical attention were common. The seizures were generalized convulsive SE in 84% and CPS status in 16%, and the overall mortality rate was 15% in 41 SE patients of our study. EEG monitoring is important to make or exclude the diagnosis of SE. Diazepam is the first choice medication and effective in the management of SE, and lately, lorazepam, midazolam, propofol and pentobarbital etc as emergency therapy. Phenytoin is also considered first-line agent in the emergency management of SE. Repetitive transcranial magnetic stimulation (rTMS) led to a prolonged latency for seizure induction after an intraperitoneal injection of pentylenetetrazol (PTZ) and effectively prevented the development of status epilepticus of PTZ-induced convulsions in the rats. Our data suggest that rTMS has suppressive effects on the neuronal excitability in rats. These effects are anticonvulsive and suggest the possibility of therapeutic use of rTMS in the patients with refractory seizures.     

Experimental secondarily generalized convulsive status epilepticus induced by D,L-homocysteine thiolactone

Secondarily generalized convulsive status epilepticus was induced by intraperitoneal (i.p.) injection of D,L-homocysteine thiolactone to rats with actively epileptogenic cobalt lesions in motor cortex. This induced focal motor seizures which secondarily generalized. Control animals not treated with antiepileptic drugs had a mean of 18.3 generalized convulsions over a mean period of 103.8 min. Electrographic patterns seen during status epilepticus are described and are very similar to those seen during human status epilepticus. Phenytoin, phenobarbital, diazepam and lorazepam were all effective in arresting the generalized seizures when given i.p. after the second such seizure. Efficacy was serum drug concentration dependent. Concentrations effective in arrest of generalized seizures in this model are similar to those reported to be effective in the treatment of human status epilepticus. Diazepam ED50s for control of generalized tonic-clonic seizures and for arrest of all seizure activity were determined.     

Effects of drugs on the initiation and maintenance of status epilepticus induced by administration of pilocarpine to lithium-pretreated rats

The ability of various drugs to prevent the onset of status epilepticus induced by administration of the muscarinic agonist, pilocarpine, to lithium-pretreated rats was determined. Motor limbic seizures and status epilepticus occurred in 100% of rats administered pilocarpine (30 mg/kg, s.c.) 20 h after pretreatment with lithium (3 meq/kg, i.p.). The latency to spike activity and to status epilepticus was 20 +/- 1 min and 24 +/- 1 min, respectively. Atropine, diazepam, phenytoin, carbamazepine, phenobarbital, paraldehyde, and L-phenylisopropyladenosine (L-PIA) prevented all phases of seizure activity induced by lithium/pilocarpine treatment. The initiation of status epilepticus was significantly prolonged by pretreatment with sodium valproate. These findings indicate that the seizures induced by administration of lithium and pilocarpine accurately model generalized tonic-clonic epilepsy. The anticonvulsant activity of L-PIA was prevented by prior treatment with the adenosine antagonist, theophylline. The latency to spike and seizure activity was decreased by theophylline, indicating that endogenous adenosine may have a tonic inhibitory influence on cholinergic neurons. Atropine, diazepam, phenobarbital, phenytoin, sodium valproate, L-PIA, and carbamazepine did not interrupt seizure activity when administered 60 min after pilocarpine (approximately 35 min after initiation of status epilepticus). When rats were administered paraldehyde at this time, status epilepticus was rapidly terminated and all rats survived. Thus, status epilepticus induced by lithium and pilocarpine provides a seizure model that is not responsive to conventional anticonvulsants.