Increased anticonvulsant effect of phenobarbital with age in mice--a possible pharmacological index for brain aging

We have recently reported that the anticonvulsant effect of phenytoin increases with age in mice (1). Since some of the mechanisms of anticonvulsant action of phenytoin and phenobarbital may be different, the present study sought to determine whether a similar increase with age in the anticonvulsant effect of phenobarbital could also be observed. The anticonvulsant effect of phenobarbital was examined in BDF1 female mice of different ages (6, 12, 24 and 30 months old) using the abolition of the tonic hindlimb extensor component of maximal electro-shock seizure as the index. The minimal effective concentration (MEC) values of phenobarbital in plasma and brain were significantly lower in aged (24 and 30 month old) mice compared with the respective values in the youngest animal group (6 month old). Series using nearly two-fold different intensities of electroshock (30 and 55 mA) showed almost identical MEC values in 24 month-old mice. It was concluded that the brain of aged mice is more sensitive to phenobarbital, as it is to phenytoin.     

Effect of anticonvulsants on human chromosomes. 2. In vitro studies

The effects of 3 anticonvulsant drugs (diphenylhydantoin, ethosuximide, and phenobarbital) on human peripheral lymphocytes in vitro were studied. The rate of chromosomal aberrations induced by the 3 anticonvulsants was significantly increased from the first concentration analyzed, similar to half the therapeutic serum concentration. These findings are compared with other previous reports.     

The effect of age on the adaptation of the brain to the anticonvulsant effect of phenobarbital in mice

The anticonvulsant effect of phenobarbital was examined in young (6 month old) and old (24 month old) BDF1 female mice consisting of three groups each (one control and two chronically dosed phenobarbital groups), using the abolition of the tonic hindlimb extensor component of maximal electroshock seizure as the index. The minimal effective concentrations (MEC) of phenobarbital in plasma and brain in old control mice that were given a vehicle (tragacanth) for one week were significantly lower in comparison to the respective values in young adult control mice with the same treatment, confirming our previous findings. In young mice chronically treated with phenobarbital for one week (20 mg/kg daily for two days followed by daily dose of 50 mg/kg for 5 days), the MECs in both plasma and brain were significantly higher compared with respective control values. The 3 week treatment also produced an increase in MEc comparable to the one-week treatment. The same one-week treatment with phenobarbital in old mice similarly caused significantly higher plasma and brain MEC values but 3-week-treatment values were not significantly different from corresponding control values. It is concluded that the development of brain adaptation to phenobarbital is almost equal for young and old mice, so that the reduction in MEC with age indicates the need for lowered dosages for the aged, even when the age effect on brain adaptation developed to chronic dosing is taken into consideration.     

Effectiveness of anticonvulsants in mice exposed to mixed gamma-neutron radiations

The effectiveness of four anticonvulsants was tested in male CF1 mice exposed to 500-, 1000-, and 10,000-rad doses of mixed gamma-neutron radiations. Prevention of the hind leg extensor component of a maximal convulsion induced by electroshock was selected as the end point for effective anticonvulsant activity of diphenylhydantoin, phenobarbital, and mephenytoin. Prevention of convulsions induced by pentylenetetrazol was the end point of effective anticonvulsant activity of trimethadione. The effectiveness of the drugs was evaluated by comparing the ED50's to the ED50 value for unirradiated controls. The anticonvulsants tested by electroshock showed a tendency toward increasing effectiveness after 500- and 1000-rad doses of radiation and a significantly increased effectiveness following 10,000 rads. Trimethadione effectiveness in irradiated mice was similar to that in unirradiated controls at all doses and times tested.     

An analysis of the in vivo interactions between chemical convulsants and anticonvulsants

The interactions between pentylenetetrazol (PTZ), picrotoxin (PIC), or bicuculline (BIC) and diazepam, phenobarbital, or valproate were subjected to Schild plot analysis. Log dose-probit response curves for minimal clonic seizures were determined for three chemical convulsants in the absence and in the presence of various concentrations of three anticonvulsants. The calculated median convulsant doses were subjected to Schild plot analysis and the pA2 values determined. A comparison of the pA2 values for the various convulsant/anticonvulsant combinations suggested the following conclusions: (i) the sequence of events leading to minimal clonic seizures evoked by PTZ or PIC involves a common receptor, (ii) BIC acts through a different receptor, and (iii) Schild plot analysis of the antagonism between convulsant and anticonvulsant is in agreement with their antagonism in vitro studies. Thus, Schild plot analysis can be useful in the evaluation of anticonvulsant activity in vivo and may offer some insight into the potential clinical usefulness of anticonvulsant substances.     

Therapeutic monitoring of anticonvulsant drugs in psychiatric patients: rapid, simultaneous gas-chromatographic determination of six commonly used anticonvulsants without interference from other drugs

A simple, sensitive and precise gas-chromatographic method for simultaneous extraction, derivatization and determination of methsuximide, ethosuximide, diphenylhydantoin, carbamazepine, phenobarbital and primidone in the presence of other drugs has been described. The method is especially useful for drug monitoring in patients on multiple anticonvulsant therapy while also on combination therapy with psychotropic drugs. It overcomes the analytical interferences between mephenytoin and phenobarbital; methsuximide and primidone; kemadrin and primidone; cholesterol and primidone; prolixin, haldol and other drugs; encountered in other methods using underivatized, trimethylsilylated or methylated drugs. As little as 0.5 microgram/ml of a drug can be determined and if needed the method can be scaled down to 0.3 ml plasma. The method yielded recoveries of 97-103% with standard deviations of 0.7-1.8. For a constant check of the precision, an internal quality control using daily analysis of a sample from a frozen plasma pool supplemented with known concentrations of the anticonvulsants was used. The method is suitable for use in routine clinical laboratory.     

Antimetrazol action of two potential anticonvulsants, CM 40907 and SR 41378, in immature rats.

The action of two potential anticonvulsants, CM 40907 (10-50 mg/kg i.p.) and SR 41378 (1.25-20 mg/kg i.p.) against metrazol-induced seizures was studied in rats 7, 12, 18 and 25 days old. Two types of motor seizures--minimal, clonic and major, generalized tonic-clonic--were elicited by a 100-mg/kg dose of metrazol (s.c.) and their incidence and latency were evaluated. The severity of seizures was expressed as a score on a 5-point scale. Dimethylsulfoxide, an organic solvent, exhibited anticonvulsant action only in doses far exceeding those used for dissolving the two anticonvulsants. Both drugs suppressed minimal as well as major seizures in all age groups studied in a dose-dependent manner, SR 41378 being approximately four times more potent than CM 40907. The latencies could be measured only in animals given low doses of anticonvulsants. CM 40907 did not change the latencies whereas SR 41378 prolonged them. The severity of seizures was decreased again in a dose-dependent manner. There were only minor changes in the efficacy of CM 40907 among the four age groups. On the contrary, SR 41378 exhibited an extreme efficacy in 7-day-old rat pups, where even the 1.25 mg/kg dose significantly decreased the incidence and severity of seizures. The efficacy in the remaining three age groups was approximately at the same level as in adult rats.     

Effects of anticonvulsants on cholinergic and GABAergic properties in the neuronal cell clone NG108-15

The effects of anticonvulsant drugs on growth, cholinergic, and GABAergic properties were examined in the neuronal cell clone NG108-15. Cells were exposed for 4 days to valproic acid, phenobarbital, phenytoin, or carbamazepine in concentrations equivalent to therapeutic free levels in human serum. Experiments were also performed with varying concentrations of a recently proposed antiepileptic, gamma-vinyl GABA. Of these five anticonvulsants, cell growth (total protein and cell counts) was decreased with valproic acid and phenytoin but only valproic acid and gamma-vinyl GABA altered neurotransmitter markers. Therapeutic concentrations of valproic acid increased choline acetyltransferase activity to 142% of control but had no effect on either the activity of glutamate decarboxylase or the level of GABA. The effects of a higher (toxic) concentration of valproic acid (200 g/ml) were similar to those induced by the differentiating agent dibutyryl cyclic AMP: both decreased cell growth, enhanced the activity of choline acetyltransferase and reduced the activity of glutamate decarboxylase. Gamma-vinyl GABA had no effect on cholinergic markers but, at 1300 g/ml, increased GABA levels to 135% of control despite the reduction of glutamate decarboxylase to 68% of control. In the NG108-15 cell clone, anticonvulsants have varying effects on cell growth, differentiation, and neurotransmitter systems. Our findings do not support the proposal that the mechanism of action for valproic acid, phenobarbital, phenytoin, and carbamazepine is via alteration of GABA levels.     

Evidence for involvement of the astrocytic benzodiazepine receptor in the mechanism of action of convulsant and anticonvulsant drugs

The anticonvulsant drugs carbamazepine, phenobarbital, trimethadione, valproic acid and ethosuximide at pharmacologically relevant concentrations inhibit [3H]diazepam binding to astrocytes in primary cultures but have much less effect on a corresponding preparation of neurons. Phenytoin as well as pentobarbital (which is not used chronically as an anticonvulsant) are equipotent in the two cell types. The convulsants picrotoxinin and pentylenetetrazol, the convulsant benzodiazepine RO 5-3663 and the two convulsant barbiturates DMBB and CHEB similarly inhibit diazepam binding to astrocytes but have little effect on neurons. On the basis of these findings it is suggested that these convulsants and anticonvulsants owe at least part of their effect to an interaction with the astrocytic benzodiazepine receptor, perhaps by interference with a calcium channel.     

Tricyclic oxazolo[2,3-f]purinediones: potency as adenosine receptor ligands and anticonvulsants

Synthesis and physicochemical properties of 7-mono- and 6,7-disubstituted dihydrooxazolo-[3,2-f]purinediones are described. Oxazolo[2,3-f]purinediones were synthesized by cyclization of 8-bromotheophylline with oxiranes. The obtained compounds (1-22) were evaluated for their affinity at adenosine A(1) and A(2A) receptors. They showed mainly adenosine A(2A) receptor affinity at low micromolar concentrations and A(2A) selectivity, for example, compound 9 with an octyl substituent at the oxazole ring displayed adenosine A(2A) receptor affinity (K(i)=0.998 microM) and at least 25-fold A(2A) versus A(1) selectivity. This compound was less selective (5-fold) towards human recombinant A(2B) and A(3) adenosine receptors. In this group of compounds active adenosine A(1) receptor antagonists were also identified. Oxazolopurinediones were evaluated in vivo as anticonvulsants in MES and ScMet tests and examined for neurotoxicity in mice (ip). Compounds with long alkyl chains showed anticonvulsant activity in both tests (in 100 and 300 mg/kg doses), accompanied by significant neurotoxicity. The anticonvulsant activity in rats (po) was higher and without signs of neurotoxicity. SAR and QSAR studies stressed the importance of lipophilic 7-substituents for both types of pharmacological activity. The volume of the substituent is, however, limited at the A(2A) AR, an n-octyl group being optimal.     

Inhibition of rat liver calciferol 25-hydroxylase activity with anticonvulsant drugs.

Diphenylhydantoin or phenobarbital adminstered for 25 days to Vitamin D-deficient rats inhibited liver calciferol 25-hydroxylase activity. This inhibition was observed with either total homogenate or the microsomal fraction. Eight days following cessation of phenobarbital treatment, liver calciferol 25-hydroxylase activity had returned to control value. Addition of diphenylhydantoin or phenobarbital in vitro to liver homogenate or microsomes isolated from rachitic untreated animals also inhibits the enzymic activity. These data suggest that the impaired conversion of Vitamin D₃ to its 25-hydroxylated metabolite may be the cause of low plasma 25-hydroxycholecalciferol levels in anticonvulsant treated patients.     

Cloning,expression, and genomic organization of mouse mp29 gene

The convulsions of approximately 25% of epileptics are inadequately controlled by currently available medication; therefore the preparation of new antiepileptic drugs is of great interest. Aryl semicarbazones can be considered a new class of compounds presenting anticonvulsant activity. In addition, they can be orally administered and are more active as anticonvulsants than mephenytoin or phenobarbital. However, one disadvantage of these compounds is their low water solubility. As a strategy to circumvent this problem, a 1:1 inclusion compound of benzaldehyde semicarbazone (BS) and hydroxypropyl-beta-cyclodextrin (HP-beta-CD) was prepared and characterized. The anticonvulsant activities of the free semicarbazone and of the inclusion compound were evaluated in rats using the maximum electroshock and audiogenic seizures screenings. In both tests the minimum dose of compound necessary to produce activity decreases from 100mg/kg for the free semicarbazone to 35 mg/kg for the inclusion compound, indicating a significant increase in the bio-availability of the drug.     

The necessity of drug level monitoring in anticonvulsant drug therapy.

A survey of 'steady-state' serum levels of anticonvulsant drugs from 221 epileptic patients at a university hospital was conducted. Serum concentrations of phenobarbital, primidone, and diphenylhydantoin were determined by a gas chromatographic method. Sixty-five percent (130) of the patients receiving diphenylhydantoin had levels below the therapeutic range of 10-20mug/ml. Subtherapeutic levels appear to be due to inadequate dosage adjustment. Only 25% (33) of the patients receiving phenobarbital had levels below the therapeutic range. Serum levels of diphenylhydantoin or phenobarbital could not be predicted from dosage. Most patients received two or more drugs. Over 10% of the patients had potentially toxic levels of anticonvulsant drugs. High levels of diphenylhydantoin were easily recognized clinically but high levels of phenobarbital were not.     

Enantioselective binding of mephobarbital to plasma proteins

The enantioselective protein binding of mephobarbital (MPB) was investigated in human plasma and human serum albumin solutions by equilibrium dialysis. A small but statistically significant difference was observed in the in vitro plasma protein binding of the enantiomers; (S)-MPB was approximately 59% bound and (R)-MPB approximately 67% bound. The binding to albumin [(S)-MPB: approximately 29% bound, and (R)-MPB: approximately 41% bound] was less than to plasma proteins but showed somewhat greater enantioselectivity, suggesting that albumin binding is a major source of the enantioselectivity in plasma. The effects of MPB concentration, of varying enantiomeric concentration ratio, and of phenobarbital on the enantioselective binding of MPB were studied. The effect of age was also investigated by measuring the binding in plasma from 8 young (18-25 yr) and 8 elderly (greater than 60 yr) male subjects who took single doses of MPB. The results were in close agreement with the in vitro binding data, and the binding of both enantiomers was marginally but significantly lower in the young compared with the elderly subjects. These differences in binding were consistent with previously observed pharmacokinetic differences between the two subject groups.     

Influence of Ivabradine on the Anticonvulsant Action of Four Classical Antiepileptic Drugs Against Maximal Electroshock-Induced Seizures in Mice

Although the role of hyperpolarization-activated cyclic nucleotide-gated (HCN) channels in neuronal excitability and synaptic transmission is still unclear, it is postulated that the HCN channels may be involved in seizure activity. The aim of this study was to assess the effects of ivabradine (an HCN channel inhibitor) on the protective action of four classical antiepileptic drugs (carbamazepine, phenobarbital, phenytoin and valproate) against maximal electroshock-induced seizures in mice. Tonic seizures (maximal electroconvulsions) were evoked in adult male albino Swiss mice by an electric current (sine-wave, 25 mA, 0.2 s stimulus duration) delivered via auricular electrodes. Acute adverse-effect profiles of the combinations of ivabradine with classical antiepileptic drugs were measured in mice along with total brain antiepileptic drug concentrations. Results indicate that ivabradine (10 mg/kg, i.p.) significantly enhanced the anticonvulsant activity of valproate and considerably reduced that of phenytoin in the mouse maximal electroshock-induced seizure model. Ivabradine (10 mg/kg) had no impact on the anticonvulsant potency of carbamazepine and phenobarbital in the maximal electroshock-induced seizure test in mice. Ivabradine (10 mg/kg) significantly diminished total brain concentration of phenytoin and had no effect on total brain valproate concentration in mice. In conclusion, the enhanced anticonvulsant action of valproate by ivabradine in the mouse maximal electroshock-induced seizure model was pharmacodynamic in nature. A special attention is required when combining ivabradine with phenytoin due to a pharmacokinetic interaction and reduction of the anticonvulsant action of phenytoin in mice. The combinations of ivabradine with carbamazepine and phenobarbital were neutral from a preclinical viewpoint.     

Phenobarbital: a locus of action on spike broadening and potassium inactivation

1. The effect of phenobarbital on frequency-dependent spike broadening and potassium inactivation was studied in snail neurons. 2. The amount of spike broadening was significantly depressed by the application of 10(-3) M phenobarbital but the time course of broadening was unaffected. 3. In voltage clamped neurons, this concentration of phenobarbital significantly depressed the amount of potassium current inactivation without altering its time constant. 4. A possible locus of phenobarbital's anticonvulsant action is through a decrease in synaptic efficacy resulting from a depression of presynaptic spike broadening.     

Antagonism of intrastriatal and intravenous kainic acid by 1-nuciferine: Comparison with various anticonvulsants and gabamimetics

1-Nuciferine has been proposed as an antagonist of kainic acid (KA) and/or glutamate on the basis of iontophoretic experimental results. Its effectiveness against KA-induced destruction of rat striatal cholinergic neurons was therefore evaluated and compared with that of diazepam, phenobarbital, baclofen, haloperidol, and related substances. Drugs were administered intraperitoneally before and after intrastriatal microinjection of KA (0.5–1.5 μg), and choline acetyltransferase activity in striatum was assessed 24 hr later. Among the substances tested, only 1-nuciferine attenuated KA-induced depletions of striatal choline acetyltransferase. This effect was not secondary to anticonvulsant activity, because (a) 1-nuciferine did not block metrazol-, maximal electroshock-, or intravenous KA-induced seizures, and (b) anticonvulsants such as phenobarbital and diazepam, which are effective in these procedures, failed to modify KA-induced striatal neurotoxicity. 1-Nuciferine antagonized certain other neurological effects of intravenous KA, but antagonism was also seen with some of the other drugs tested. Intrastriatal microinjection of KA and/or glutamate may offer a means to detect selective antagonism of KA and/or glutamate, as distinguished from simple anticonvulsant activity.     

Effect of chronic valproate treatment on folate-dependent methyl biosynthesis in the rat

Folate deficency has been associated with chronic anticonvulsant therapy. Characterization of the effects of individual anticonvulsants has been undertaken. Chronic treatmennt of rats with sodium valproate caused a decrease in liver folate concentration with concomitant increases in brain and plasma folate concentrations. After several weeks, these trends were reversed and folate concentrations tended to normalize. Chronic valproate treatment affected the activities of folatedependent one-carbon enzymes: Serine hydroxymethyltransferase activity in liver was increased; methylenetetrahydrofolate reductase activity in both brain and liver was decreased; and methyltetrahydrofolate: homocysteine methyltransfrase activity in both brain and liver decreased initially but returned toward normal with continued treatment. Methionine adenosyltransferase activity in brain declined after several weeks of treatment but the concentration of S-adenosylmethionine in liver increased with chronic valproate treatment. These data are consistent with the hypothesis that the effects of anticonvulsants on folates are a consequence of the mechanism of action of the anticonvulsant.Abbreviations SHMT serine hydroxymethyltransferase - MAT methiuonine adenosyltransferase - MHMT methyltetrahydrofolate: homocysteine methyltransferase - MTR methylenetetrahydrofolate reductase - AdoMet S-adenosylmethionine Supported by the Research Service of the Veterans Administration and by Grant #AM30865 from NIH.     

Actions of vitamins D2 and D3 and 25-OHD3 in anticonvulsant osteomalacia.

In 54 epileptic outpatients treated for at least one year with anticonvulsants the bone mineral content (B.M.C.), an estimate of total body calcium, and serum calcium were measured before and during treatment with three doses of cholecalciferol (vitamin D3; 200, 100, and 50 mu-g daily) and 25-hydroxycholecalciferol (25-OHD3; 40, 20, and 10 mu-g daily) for 12 weeks. The results, when compared with the effects of calciferol (vitamin D2; 200, 100, and 50 mu-g daily) in 40 epileptic outpatients, showed different actions in anticonvulsant osteomalacia of vitamin D2 on the one hand and vitamin D3 and 25-OHD3 on the other. In the patients who received vitamin D2 an increase in B.M.C. was found whereas serum calcium was unchanged. The patients who received vitamin D3 or 25-OHD3 showed an increase in serum calcium but unchanged values of B.M.C. The results suggest that liver enzyme induction cannot alone explain anticonvulsant osteomalacia.     

Anticonvulsant drugs and the genetically epilepsy-prone rat

Anticonvulsant drugs were evaluated in members of two colonies of genetically epilepsy-prone rats (GEPR). Virtually all of the animals in the first colony experience a wild running fit that terminates in a generalized clonic convulsion when they are stimulated by sound. According to our convulsion intensity scoring system, these animals have an audiogenic response score (ARS) of 3 and the colony is designated the GEPR-3 colony. In the second colony, more than 95% of the animals experience a wild running phase terminating in a tonic extensor convulsion when they are stimulated by sound. That is, they have an ARS of 9 and the colony is designated the GEPR-9 colony. All of the established antiepileptic drugs that were tested produced anticonvulsant effects in the GEPR. Three tricyclic antidepressant agents acted as anticonvulsants in doses substantially lower than the toxic doses that produced spontaneous convulsions. Two of the established anticonvulsants, phenobarbital and ethosuximide, produced anticonvulsant effects in very similar doses in members of GEPR-3 and GEPR-9 colonies. Valproic acid produced an anticonvulsant effect in GEPR-3 in significantly lower doses than in GEPR-9. Carbamazepine, phenytoin, imipramine, amitriptyline, and desipramine produced anticonvulsant effects in essentially equimolar doses and in each case the protective dose was significantly lower in GEPR-9 than in GEPR-3 colonies. GEPR did not experience the convulsive effects of imipramine, amitriptyline, and desipramine at lower doses than did control animals. Thus, these epilepsy-prone animals are no more likely to experience convulsions in response to overdose of one of these three drugs than are nonepileptic subjects.