Oxidative Stress Contributes to Status Epilepticus Associated Mortality

Status epilepticus is a common manifestation of nerve agent toxicity and represents a serious medical emergency with high rates of mortality and neurologic injury in those that survive. The aim of the current study was to determine if targeting oxidative stress with the catalytic antioxidant, AEOL10150, would reduce pilocarpine-induced mortality and attenuate neuronal death and neuroinflammation. We found that treatment with AEOL10150 in conjunction with scopolamine and diazepam following pilocarpine-induced SE was able to significantly reduce mortality compared to treatment with just scopolamine and diazepam. Mortality was further reduced when AEOL10150 was used in conjunction with atropine and diazepam which is considered the standard of care for nerve agent exposures. Both treatment paradigms offered significant protection against SE-induced oxidative stress. Additionally, treatment with scopolamine, AEOL10150 and diazepam attenuated SE-induced neuronal loss and neuroinflammation. Taken together, the data suggest that pharmacological targeting of oxidative stress can improve survival and attenuate secondary neurological damage following SE induced by the nerve agent surrogate pilocarpine.     

癫痫持续状态的发病危险因素分析

目的:探讨癫痫持续状态的发病危险因素。方法:对西京医院神经内科2000年1月至2009年11月连续登记住院的癫痫持续状态患者的临床资料进行回顾性分析,采用条件logistic回归方法筛选癫痫持续状态的危险因素。结果:共收集98例癫痫持续状态患者,一般情况显示:男性发病率明显高于女性,成人发病率明显高于儿童,CSE发生率明显高于NCSE;logistic回归结果显示:中枢神经系统感染(OR值为4.74)为SE的主要危险因素,其次为脑血管病(OR值为3.93)和颅脑外伤(OR值为1.84)。SE发作的有明显诱因的占19例,其中上呼吸道感染伴发热者比例较高。结论:中枢神经系统感染、脑血管病、脑外伤是癫痫持续状态最主要的危险因素,急性上呼吸道感染伴发热者最常见的诱因。预防感染、防治脑血管病、避免外伤,减少各种诱因是预防本病的关键。     

Dangers of Treatment of Status Epilepticus with Diazepam

The results of treatment of 25 patients admitted from psychiatric institutions indicate that diazepam is the drug of first choice in the treatment of status epilepticus. The dangers of treatment appeared to result from combined use with other drugs. Respiratory depression occurred in one patient and hypotension in five patients, all of whom had been given intramuscular phenobarbitone in addition to intravenous diazepam. The two serious cases of hypotension had also been given parenteral paraldehyde.     

Gabapentin Administration Reduces Reactive Gliosis and Neurodegeneration after Pilocarpine-Induced Status Epilepticus

The lithium-pilocarpine model of epilepsy reproduces in rodents several features of human temporal lobe epilepsy, by inducing an acute status epilepticus (SE) followed by a latency period. It has been proposed that the neuronal network reorganization that occurs during latency determines the subsequent appearance of spontaneous recurrent seizures. The aim of this study was to evaluate neuronal and glial responses during the latency period that follows SE. Given the potential role of astrocytes in the post-SE network reorganization, through the secretion of synaptogenic molecules such as thrombospondins, we also studied the effect of treatment with the α2δ1 thrombospondin receptor antagonist gabapentin. Adult male Wistar rats received 3 mEq/kg LiCl, and 20 h later 30 mg/kg pilocarpine. Once SE was achieved, seizures were stopped with 20 mg/kg diazepam. Animals then received 400 mg/kg/day gabapentin or saline for either 4 or 14 days. In vitro experiments were performed in dissociated mixed hippocampal cell culture exposed to glutamate, and subsequently treated with gabapentin or vehicle. During the latency period, the hippocampus and pyriform cortex of SE-animals presented a profuse reactive astrogliosis, with increased GFAP and nestin expression. Gliosis intensity was dependent on the Racine stage attained by the animals and peaked 15 days after SE. Microglia was also reactive after SE, and followed the same pattern. Neuronal degeneration was present in SE-animals, and also depended on the Racine stage and the SE duration. Polysialic-acid NCAM (PSA-NCAM) expression was increased in hippocampal CA-1 and dentate gyrus of SE-animals. Gabapentin treatment was able to reduce reactive gliosis, decrease neuronal loss and normalize PSA-NCAM staining in hippocampal CA-1. In vitro, gabapentin treatment partially prevented the dendritic loss and reactive gliosis caused by glutamate excitotoxicity. Our results show that gabapentin treatment during the latency period after SE protects neurons and normalizes PSA-NCAM probably by direct interaction with neurons and glia.     

姜黄素对癫痫大鼠认知功能障碍的预防作用及其可能机制

目的:探讨姜黄素(curcumin)对癫痫大鼠认知功能障碍的预防作用及其可能机制。方法:将30只成年雄性SD大鼠分为正常对照组、单纯致痫组(SE组)、姜黄素[60mg/(kg.d)]干预组(curcumin组)。采用Morris水迷宫方法检测大鼠学习记忆功能变化,并检测脑片水平的长时程增强(LTP)变化,处死大鼠后取脑组织并匀浆,测超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)、谷胱甘肽(GSH)、丙二醛(MDA)的水平。结果:(1)SE组大鼠寻找平台的潜伏期明显长于对照组,具有统计学意义(P<0.05),姜黄素组寻找平台的潜伏期相对于SE组显著缩短(P<0.05)。撤离平台后,SE组大鼠在平台所在象限的停留时间明显短于对照组(P<0.05),姜黄素治疗后大鼠在平台所在象限的停留时间较SE组显著延长(P<0.05)。(2)给予HFS刺激后各组兴奋性突出后电位(fEPSP)斜率较前明显增加,均可持续1h以上,与对照组比较SE组HFS刺激后fEPSP斜率明显减小(P<0.05),姜黄素可减轻SE所致的fEPSP斜率减小(P<0.05)。(3)SE组SOD、GSH-PX、GSH显著下降,MDA明显增高,姜黄素可逆转上述现象,有统计学意义(P<0.05)。结论:姜黄素可显著减轻癫痫持续状态所致的大鼠认知功能障碍,减轻海马区的氧化应激反应从而保护海马海马是其可能机制之一。     

Age-Dependent Changes in Intrinsic Neuronal Excitability in Subiculum after Status Epilepticus

Kainic acid-induced status epilepticus (KA-SE) in mature rats results in the development of spontaneous recurrent seizures and a pattern of cell death resembling hippocampal sclerosis in patients with temporal lobe epilepsy. In contrast, KA-SE in young animals before postnatal day (P) 18 is less likely to cause cell death or epilepsy. To investigate whether changes in neuronal excitability occur in the subiculum after KA-SE, we examined the age-dependent effects of SE on the bursting neurons of subiculum, the major output region of the hippocampus. Patch-clamp recordings were used to monitor bursting in pyramidal neurons in the subiculum of rat hippocampal slices. Neurons were studied either one or 2-3 weeks following injection of KA or saline (control) in immature (P15) or more mature (P30) rats, which differ in their sensitivity to KA as well as the long-term sequelae of the KA-SE. A significantly greater proportion of subicular pyramidal neurons from P15 rats were strong-bursting neurons and showed increased frequency-dependent bursting compared to P30 animals. Frequency-dependent burst firing was enhanced in P30, but not in P15 rats following KA-SE. The enhancement of bursting induced by KA-SE in more mature rats suggests that the frequency-dependent limitation of repetitive burst firing, which normally occurs in the subiculum, is compromised following SE. These changes could facilitate the initiation of spontaneous recurrent seizures or their spread from the hippocampus to other parts of the brain.     

谷氨酸转运体对癫痫持续状态大鼠突触可塑性的影响

探讨了在大鼠癫痫持续状态模型,谷氨酸转运体功能改变对突触可塑性的影响.健康成年雄性Wistar大鼠((304.06±13.79)g)随机分为5组,短期癫痫实验组(SE)及其对照组(SC),长期癫痫实验组(LE)及其对照组(LC),健康对照组(Sham).匹鲁卡品皮下注射(25 mg/kg)建立癫痫模型,建模14天后SE和LE组大鼠右侧海马内注射谷氨酸转运体抑制剂TBOA(7.5 nmol,lμ1),SC和LC组注射相同剂量的人工脑脊液.注射药物2 h后,SE和SC组检测脑电图(EEG):药物注射后2周,LJ巳和LC组检测内嗅区前穿通纤维-海马齿状回(PP-DG)长时程增强(LTP)和EEG.电生理学检测后动物灌流取脑做Fluoro-Jade-B染色.结果表明:脑电功率谱分析,SE组theta波段能量较sc组明显下降(P＜0.05),LE组与其对照Lc组相比,EEG的也theta波段能量无明显差异(P＞0.05);LTP检测显示.LE组与对照LC组相比,兴奋性突触后电位(EPSP)斜率升高(P＜0.01);Fluoro-Jade-B染色显示,LE组与对照LC组相比,给予TBOA 2周后细胞变性明显增加.结果提示,癫痫持续状态后,海马神经元损伤,TBOA导致谷氨酸转运体功能障碍,加重癫痫所至神经元损伤,对海马区突触可塑性产生影响.     

Risk Factors Associated with Death in In-Hospital Pediatric Convulsive Status Epilepticus

Objective

To evaluate in-patient mortality and predictors of death associated with convulsive status epilepticus (SE) in a large, multi-center, pediatric cohort.

Patients and Methods

We identified our cohort from the KID Inpatient Database for the years 1997, 2000, 2003 and 2006. We queried the database for convulsive SE, associated diagnoses, and for inpatient death. Univariate logistic testing was used to screen for potential risk factors. These risk factors were then entered into a stepwise backwards conditional multivariable logistic regression procedure. P-values less than 0.05 were taken as significant.

Results

We identified 12,365 (5,541 female) patients with convulsive SE aged 0–20 years (mean age 6.2 years, standard deviation 5.5 years, median 5 years) among 14,965,571 pediatric inpatients (0.08%). Of these, 117 died while in the hospital (0.9%). The most frequent additional admission ICD-9 code diagnoses in addition to SE were cerebral palsy, pneumonia, and respiratory failure.Independent risk factors for death in patients with SE, assessed by multivariate calculation, included near drowning (Odds ratio [OR] 43.2; Confidence Interval [CI] 4.4–426.8), hemorrhagic shock (OR 17.83; CI 6.5–49.1), sepsis (OR 10.14; CI 4.0–25.6), massive aspiration (OR 9.1; CI 1.8–47), mechanical ventilation >96 hours (OR9; 5.6–14.6), transfusion (OR 8.25; CI 4.3–15.8), structural brain lesion (OR7.0; CI 3.1–16), hypoglycemia (OR5.8; CI 1.75–19.2), sepsis with liver failure (OR 14.4; CI 5–41.9), and admission in December (OR3.4; CI 1.6–4.1). African American ethnicity (OR 0.4; CI 0.2–0.8) was associated with a decreased risk of death in SE.

Conclusion

Pediatric convulsive SE occurs in up to 0.08% of pediatric inpatient admissions with a mortality of up to 1%. There appear to be several risk factors that can predict mortality. These may warrant additional monitoring and aggressive management.     

Myo-Inositol Treatment and GABA-A Receptor Subunit Changes After Kainate-Induced Status Epilepticus

Identification of compounds preventing the biochemical changes that underlie the epileptogenesis process is of great importance. We have previously shown that myo-Inositol (MI) daily treatment prevents certain biochemical changes that are triggered by kainic acid (KA)-induced status epilepticus (SE). The aim of the current work was to study the further influence of MI treatment on the biochemical changes of epileptogenesis and focus on changes in the hippocampus and neocortex of rats for the following GABA-A receptor subunits: α1, α4, γ2, and δ. After SE, one group of rats was treated with saline, while the second group was treated with MI. Control groups that were not treated by the convulsant received either saline or MI administration. 28–30 h after the experiment, a decrease in the amount of the α1 subunit was revealed in the hippocampus and MI had no significant influence on it. On the 28th day of the experiment, the amount of α1 was increased in both the KA? and KA + MI-treated groups. The α4 and γ2 subunits were strongly reduced in the hippocampus of KA-treated animals, but MI significantly halted this reduction. The effects of MI on α4 and γ2 subunit changes were significantly different between hippocampus and neocortex. On the twenty-eighth day after SE, a decrease in the amount of α1 was found in the neocortex, but MI treatment had no effect on it. The obtained results indicate that MI treatment interferes with some of the biochemical processes of epileptogenesis.     

姜黄素对癫痫大鼠认知功能障碍的预防作用及其可能机制

目的：探讨姜黄素（curcumin）对癫痫大鼠认知功能障碍的预防作用及其可能机制。方法：将30只成年雄性SD大鼠分为正常对照组、单纯致痫组（SE组）、姜黄素[60mg／（kg·d）]干预组（curcumin组）。采用MorriS水迷宫方法检测大鼠学习记忆功能变化,并检测脑片水平的长时程增强（LTP）变化,处死大鼠后取脑组织并匀浆,测超氧化物歧化酶（SOD）、谷胱甘肽过氧化物酶（GSH．PX）、谷胱甘肽（GSH）、丙二醛（MDA）的水平。结果：（1）SE组大鼠寻找平台的潜伏期明显长于对照组,具有统计学意义（P〈0．05）,姜黄素组寻找平台的潜伏期相对于SE组显著缩短（P〈0．05）。撤离平台后,SE组大鼠在平台所在象限的停留时间明显短于对照组（P〈0．05）,姜黄素治疗后大鼠在平台所在象限的停留时间较SE组显著延长（P〈0．05）。（2）给予HFS刺激后各组兴奋性突出后电位（fEPSP）斜率较前明显增加,均可持续1h以上,与对照组比较SE组HFS刺激后fEPSP斜率明显减小（P〈0．05）,姜黄素可减轻SE所致的fEPSP斜率减小（P〈0．05）。（3）SE组SOD、GSH—PX、GSH显著下降,MDA明显增高,姜黄素可逆转上述现象,有统计学意义（P〈0．05）。结论：姜黄素可显著减轻癫痫持续状态所致的大鼠认知功能障碍,减轻海马区的氧化应激反应从而保护海马海马是其可能机制之一。     

抗乙型肝炎病毒药物评价用实验动物模型现状

乙型肝炎病毒(HBV)感染严重影响人类的健康,感染HBV的慢性患者可引起肝硬化、肝细胞癌及肝功丧失等病症.开发有效的抗HBV药物,对于其感染的治疗非常关健.HBV具有非常窄的宿主范围,因此选择合适的药物评价用动物模型至关重要,常用的模型动物有鸭、土拔鼠、黑猩猩及近年研究的转基因小鼠等.     

Involvement of Nitric Oxide in Spatial Memory Deficits in Status Epilepticus Rats

Status epilepticus (SE) is associated with a significant risk of cognitive impairment, and the increase of nitric oxide (NO) releasing has been reported during SE. We investigated the effects of neuronal nitric oxide synthase (nNOS) inhibitor, 7-nitroindazole (7-NI) and inducible nitric oxide synthase (iNOS) inhibitor, aminoguanidine (AG), on spatial performance of rats in the Morris water maze. Treatment with 7-NI, but not with AG, improved the performance of rats after SE not only in acquisition of the task but also in probe test. Furthermore, the level of SE-induced malondialdehyde (MDA), end product of lipid peroxidation, was significantly decreased only in animals receiving 7-NI injection. Taken together, the results of the present study provided evidence that the NO pathway contributed to oxidative stress after SE, and nNOS/NO pathway may underlie one of the potential mechanisms contributing to SE-induced spatial memory deficits.