Fármacos antiepilépticos usados en el embarazo y sus consecuencias sobre los resultados fetales: una revisión de la literatura / Antiepileptic drugs used in pregnancy and their consequences on fetal outcomes: a review of the literature

Los riesgos teratogénicos ocasionados por la exposición intrauterina a fármacos antiepilépticos (FAE) son conocidos, por lo que su prescripción se mantiene bajo estricto control. Describir los efectos adversos fetales de la exposición a FAE durante la gestación, reportados en la literatura durante el período 2016-2022. Revisión sistematizada de estudios que reportaron los efectos adversos fetales inducidos por la exposición a FAE en mujeres embarazadas en tratamiento por diagnósticos neurológicos, principalmente de epilepsia. La búsqueda se realizó en PubMed, Cochrane, Web of Science, SCOPUS, Biblioteca Virtual en Salud, Lilacs y SciELO. Se identificaron 37 artículos distribuidos en 13 países de Asia, Europa, América del Norte y Oceanía. Se observaron resultados perinatales adversos, tanto físicos como cognitivos, en la mayoría de los estudios. Los fármacos identificados como los más utilizados en los últimos años fueron valproato, topiramato, carbamazepina, lamotrigina y levetiracetam. Los FAE tienen potencial teratogénico en distintos grados de riesgo, provocando anomalías congénitas o efectos adversos en múltiples sistemas del cuerpo humano, siendo los sistemas nervioso, circulatorio y osteomuscular los más afectados.

The teratogenic risks caused by intrauterine exposure to antiepileptic drugs (AED) are known, so their prescription is kept under strict control. To describe the fetal adverse effects AED exposure during gestation, reported in the literature during the period 2016-2022. Systematized review of studies that reported fetal adverse effects induced for the exposure to AED in pregnant women in treatment for neurological diagnoses, mainly epilepsy. The search was carried out in PubMed, Cochrane, Web of Science, SCOPUS, Virtual Health Library, Lilacs and SciELO. 37 articles distributed in thirteen countries in Asia, Europe, North America and Oceania were identified. Adverse perinatal outcomes, both physical and cognitive, were observed in most studies. The most common drugs identified were valproate, topiramate, carbamazepine, lamotrigine and levetiracetam. AED have teratogenic potential in different degrees of risk, causing congenital anomalies or adverse effects in multiple systems of the human body, being the nervous, circulatory and musculoskeletal systems the most affected.

Non-Status Epilepticus female rats show seizure-like behaviors in the chronic phase of Pilocarpine experimental model / Ratas sem Status Epilepticus apresentam comportamento do tipo crise epiléptica na fase crônica do modelo experimental da Pilocarpina

Only few studies have focus on animals that received Pilocarpine (Pilo) and did not develop behavioral status epilepticus (SE) and, whether they may become epileptic in the model's chronic phase. Previews works observed mossy fiber sprouting in the hippocampus of Non-SE (NSE) rats, while others observed spontaneous and recurrent seizures (SRS) 6 - 8 months after animals received Pilo. It is known that neuronal excitability is influenced by female hormones, as well as, the occurrence of SE in castrated and non-castrated female rats. However, it is not known whether females that received Pilo and did not show SE, may have SRS. The aim of this work was to investigate whether castrated and non-castrated female rats that did not show behavioral SE after Pilo, will develop SRS in the following one-year. For that, animals received 360 mg/kg of Pilo and were video monitored for 12 months. SE females from castrated and non-castrated groups became epileptic since the first month after drug injection. Epileptic behaviors were identified watching video monitoring recordings in the fast speed. Castrated and Non castrated NSE animals showed behaviors resembling seizures described by Racine Scale stages 1 - 3. Motor alterations showed by NSE groups could be observed only when recordings were analyzed in slow speed. In addition, behavioral manifestations as, rhythmic head movements, sudden head movements, whole body movements and immobility were also observed in both, SE and NSE groups. We concluded that NSE female rats may have become epileptic. Adding to it, slow speed analysis of motor alterations was essential for the observation of NSE findings, which suggests that possibly many motor alterations have been underestimated in epilepsy experimental research.

Poucos são os estudos com foco em animais que receberam Pilocarpina (Pilo) e não desenvolveram status epilepticus (SE) comportamental e, se os mesmos se tornarão epilépticos na fase crônica do modelo. Autores observaram o brotamento das fibras musgosas no hipocampo de ratos Não-SE (NSE), enquanto outros observaram crises espontâneas e recorrentes (CER) 6 - 8 meses após receberam a droga. A excitabilidade neuronal é influenciada pelos hormônios femininos e, da mesma forma, a ocorrência de SE em ratas castradas e não-castradas. Entretanto, não é sabido se as fêmeas que não apresentam SE terão CER. O objetivo deste trabalho foi investigar se fêmeas castradas e não castradas que não tiveram SE comportamental após a injeção de Pilo desenvolverão CER dentro de um ano. Para isto, os animais receberam 360 mg/kg de Pilo e foram videomonitorados por 12 meses. As fêmeas SE castradas e não-castradas se tornaram epilépticas desde o primeiro mês pós Pilo. O comportamento epiléptico foi identificado assistindo as gravações na velocidade rápida. As fêmeas NSE castradas e não-castradas apresentaram comportamentos similares aos estágios 1 - 3 da Escala de Racine. As alterações motoras nestes grupos (NSE) foram observadas apenas quando as videomonitoração foi analisada na velocidade lenta. Além destas, manifestações comportamentais como movimentos rítmicos da cabeça, movimentos súbitos da cabeça, movimentos de todo o corpo e imobilidade também foram observadas em ambos grupos, SE e NSE. Concluímos que as fêmeas NE podem ter se tornado epilépticas. Adicionado a isto, a análise das alterações motoras na velocidade lenta foi essencial para a observação dos achados das fêmeas NSE, o que sugere que possivelmente muitas alterações motoras têm sido subestimados na pesquisa em epilepsia experimental.

Effects of scorpion venom heat-resistant peptide on the hippocampal neurons of kainic acid-induced epileptic rats

Scorpion venom is a Chinese medicine for epilepsy treatment, but the underlying mechanism is not clear. Scorpion venom heat-resistant peptide (SVHRP), a peptide isolated from the venom of Buthus martensii Karsch, has an anti-epileptic effect by reducing seizure behavior according to a modified Racine scale. The present study aimed to investigate the molecular mechanism of SVHRP on temporal lobe epilepsy. The hippocampus and hippocampal neurons from kainic acid-induced epileptic rats were treated with SVHRP at different doses and duration. Quantitative RT-PCR and immunoblotting were used to detect the expression level of brain-derived neurotrophic factor (BDNF), neuropeptide Y (NPY), cAMP-response element binding protein (CREB), stromal interaction molecule (STIM), and calcium release-activated calcium channel protein 1 (ORAI1). In the hippocampal tissues and primary hippocampal neuron cultures, SVHRP treatment resulted in increased mRNA and protein levels of BDNF and NPY under the epileptic condition. The upregulation of BDNF and NPY expression was positively correlated with the dose level and treatment duration of SVHRP in hippocampal tissues from kainic acid-induced epileptic rats. On the other hand, no significant changes in the levels of CREB, STIM, or ORAI1 were observed. SVHRP may exhibit an anti-epileptic effect by upregulating the expression of BDNF and NPY in the epileptic hippocampus.

The effect of vortioxetine on penicillin-induced epileptiform activity in rats / O efeito da vortioxetina sobre a atividade epileptiforme induzida pela penicilina em ratos

ABSTRACT Vortioxetine is a multimodal antidepressant agent that modulates 5-HT receptors and inhibits the serotonin transporter. It is indicated especially in cases of major depressive disorder related to cognitive dysfunction. There are many studies investigating the effects of antidepressants on the seizure threshold and short-term epileptic activity. However, the effect of vortioxetine on epileptic seizures is not exactly known. Our aim was to investigate the effects of vortioxetine on penicillin-induced epileptiform activity. Twenty-seven Wistar rats were divided into three groups: sham-control group, positive control group (diazepam), and vortioxetine group. After a penicillin-induced epilepsy model was formed in each of the three groups of animals, 0.1 ml of saline was administered to the control group, 0.1 ml (10 mg/kg) vortioxetine was administered in the vortioxetine group, and 0.1 mL (5 mg/kg) of diazepam was administered in the positive control group, intraperitoneally. The epileptic activity records were obtained for 120 minutes after the onset of seizure. There was no significant difference in spike wave activity between the vortioxetine and diazepam groups, whereas this was significantly reduced in the vortioxetine group compared with the controls. The administration of vortioxetine at a dose of 10 mg/kg immediately after the seizure induction significantly decreased the spike frequencies of epileptiform activity compared with the control group. No significant difference was found between the vortioxetine and positive controls. This study showed that vortioxetine reduces the number of acutely-induced epileptic discharges. Vortioxetine may be an important alternative for epileptic patients with major depressive disorder-related cognitive dysfunction.

RESUMO A vortioxetina é um agente antidepressivo multimodal que modula os receptores 5HT e inibe o transportador de serotonina. Está indicada, principalmente nos casos de transtorno depressivo maior (TDM), relacionado à disfunção cognitiva. Existem muitos estudos que investigam os efeitos dos antidepressivos no limiar convulsivo e na atividade epiléptica de curto prazo. No entanto, o efeito da vortioxetina nas crises epilépticas não é exatamente conhecido. Nosso objetivo é investigar os efeitos da vortioxetina sobre a atividade epileptiforme induzida pela penicilina. Vinte e sete ratos Wistar foram divididos em três grupos, grupo controle-sham, grupo controle positivo (Diazepam) e grupo vortioxetina. Depois, 0,1 mg (10 mg / kg) de vortioxetina foi administrado no grupo vortioxetina, e 0,1 ml (5 mg / kg) / kg) de diazepam foi administrado no grupo de controle positivo intraperitonealmente. Os registros de atividade epiléptica foram obtidos durante 120 minutos após o início da convulsão. Não houve diferença significativa na atividade de pico entre o grupo de voritoxetina e diazepam, embora tenha sido significativamente reduzida no grupo de vortioxetina em comparação com os controles. A administração de vortioxetina na dose de 10 mg / kg imediatamente após a indução das convulsões diminuiu significativamente as frequências de espícula da atividade epileptiforme em comparação com o grupo controle. Nenhuma diferença significativa foi encontrada entre a vortioxetina e controles positivos. Este estudo mostrou que a vortioxetina reduz o número de descargas epilépticas agudamente induzidas. A vortioxetina pode ser uma alternativa importante para pacientes epilépticos com disfunção cognitiva relacionada à TDM.

1-triacontanol cerotate isolated from Marsilea quadrifolia Linn. safeguards hippocampal CA3 neurons and augments special memory deficit in chronic epileptic rats / Cerotato de 1-triacontanol aislado de Marsilea quadrifolia Linn. protege las neuronas CA3 del hipocampo y mejora el déficit de memoria especial en ratas epilépticas crónicas

SUMMARY: Currently many people with epilepsy do not have seizure control even with the best available medications. Moreover various antiepileptics have adverse cognitive impact with other side effect. Thus, need for new antiepileptic drugs still remains challenge. However, many of the natural components have antiepileptic action and this fact remains scientifically unexplored. This study was designed to check the behavioral and neuro-pathological outcome of 1-Triacontanol cerotate (1TAC), isolated from Marsilea quadrifolia Linn. (MQ) on chronic Pentylenetetrazol (PTZ) kindling model of epilepsy in rats. Two-month-old adult male Wistar rats (n=60) were randomly divided into six groups; Group I (Cage Control), II (Vehicle Control), III (Positive Control), IV (Standard drug treated), V (1TAC: 40 mg/kg) & VI (1TAC: 80 mg/kg). To induce kindling a 35 mg/kg dose of PTZ was injected i.p. in every 48 hrs for 30 days in Group III to VI. Spatial memory performance was tested using Morris water maze, following which brains were further processed for histopathological investigations. Interestingly, 1TAC was able to minimize the loss of pyramidal cells in hippocampal CA3 region. These cellular changes were behaviorally responded as improved special learning and memory, a better spatial navigation and object place configuration. The current study strongly implicates that 1TAC from MQ has potent neuroprotective role and augments special memory deficit in chronic epileptic rats. The isolated component which attenuates spatial memory performance could be beneficial outcome to retain cognitive blunting in chronic epilepsy.

RESUMEN: Actualmente, muchas personas con epilepsia no cuentan con un control adecuado de las convulsiones, incluso con los mejores medicamentos disponibles. Además, varios antiepilépticos tienen un impacto cognitivo adverso además de efectos secundarios. Por lo tanto, la necesidad de nuevos fármacos antiepilépticos sigue siendo un desafío. Sin embargo, muchos de los componentes naturales tienen acción antiepiléptica y este hecho permanece científicamente inexplorado. Este estudio se diseñó para verificar el resultado conductual y neuro-patológico del cerotato de 1-triacontanol (1TAC), aislado de Marsilea quadrifolia Linn. (MQ) en el modelo de epilepsia en ratas del pentilenetetrazol (PTZ) crónico (PTZ). Ratas Wistar adultas de dos meses de edad (n = 60) se dividieron aleatoriamente en seis grupos; Grupo I (Control de jaula), II (Control de vehículo), III (Control positivo), IV (Medicamento estándar de tratamiento), V (1TAC: 40 mg / kg) y VI (1TAC: 80 mg / kg). Para inducir la inflamación se inyectó una dosis de 35 mg / kg de PTZ i.p. en cada 48 horas durante 30 días en los grupos III a VI. El rendimiento de la memoria espacial se probó utilizando el laberinto de agua de Morris, después de lo cual se procesaron los cerebros para investigaciones histopatológicas. Curiosamente, 1TAC pudo minimizar la pérdida de células piramidales en la región CA3 del hipocampo. Estos cambios celulares respondieron de manera conductual como una mejora del aprendizaje especial y la memoria, una mejor navegación espacial y la configuración del lugar del objeto. El estudio actual implica fuertemente que 1TAC de MQ tiene un potente papel neuroprotector y mejora el déficit de memoria especial en ratas epilépticas crónicas. El componente aislado que atenúa el rendimiento de la memoria espacial podría ser un resultado beneficioso para retener la reducción cognitiva en la epilepsia crónica.

Air pollution and risk of hospitalization for epilepsy: the role of farm use of nitrogen fertilizers and emissions of the agricultural air pollutant, nitrous oxide / Poluição do ar e risco de hospitalização por epilepsia: o papel do uso agrícola de fertilizantes nitrogenados e as emissões de poluente atmosférico agrícola, óxido nitroso

ABSTRACT The link between various air pollutants and hospitalization for epilepsy has come under scrutiny. We have proposed that exposure to air pollution and specifically the pervasive agricultural air pollutant and greenhouse gas, nitrous oxide (N2O), may provoke susceptibility to neurodevelopmental disorders. Evidence supports a role of N2O exposure in reducing epileptiform seizure activity, while withdrawal from the drug has been shown to induce seizure-like activity. Therefore, we show here that the statewide use of anthropogenic nitrogen fertilizers (the most recognized causal contributor to environmental N2O burden) is significantly negatively associated with hospitalization for epilepsy in all three pre-specified hospitalization categories, even after multiple pollutant comparison correction (p<.007), while the other identified pollutants were not consistently statistically significantly associated with hospitalization for epilepsy. We discuss potential neurological mechanisms underpinning this association between air pollutants associated with farm use of anthropogenic nitrogen fertilizers and hospitalization for epilepsy.

RESUMO A ligação entre vários poluentes do ar e a hospitalização por epilepsia tem sido examinada. Propusemos que a exposição à poluição do ar, especificamente ao poluente atmosférico generalizado e ao gás de efeito estufa, o óxido nitroso (N2O), poderiam fomentar a susceptibilidade a distúrbios do desenvolvimento neurológico. A evidência apoia o papel da exposição ao N2O na redução da atividade convulsiva epileptiforme, enquanto mostra que a retirada do fármaco induz atividade pseudo-convulsiva. Portanto, mostramos aqui que o uso a nível estatal de fertilizantes nitrogenados antropogênicos (o agente causal mais reconhecido para a carga ambiental de N2O) está significativa e negativamente associado à hospitalização por epilepsia nas três categorias de hospitalização pré-especificadas, mesmo após a correção de comparação de poluentes múltiplos (p <0,007 ), enquanto os outros poluentes identificados não foram consistentemente associados de forma estatística com a hospitalização por epilepsia. Discutimos possíveis mecanismos neurológicos subjacentes a esta associação entre poluentes atmosféricos associados ao uso agrícola de fertilizantes nitrogenados antropogênicos, e hospitalização por epilepsia.

Neurocysticercosis in asplenic patient, case report / Neurocisticercose em paciente asplênico, relato do caso

Neurocysticercosis is an important cause of neurologic and psychiatric disorders; it is a frequent etiology for acquired epilepsy worldwide. The parasitic infection of Taenia solium (including larval dissemination to the nervous system) can be avoided by effective means of prevention. Nonetheless, this disease remains endemic in many regions of the world. To demonstrate the importance of prophylaxis this paper reports the case of a patient without spleen, who was treated for neurocysticercosis manifested by epilepsy. In twenty years of follow up, the patient did not experience a repeat occurrence of neurocysticercosis, despite of immunological impairment (absence of spleen) and environmental exposure (living in an endemic area). Prevention was guided by a regular use of anthelmintic (Albendazole) and health education.

Neurocisticercose é uma importante causa de doenças neurológicas e psiquiátricas, é uma frequente etiologia de epilepsia adquirida, no mundo. A infecção parasitária da Taenia solium (incluindo a disseminação das larvas para o sistema nervoso) pode ser evitada por meios eficazes de prevenção; no entanto, esta enfermidade ainda é endêmica em muitas regiões do mundo. Para demonstrar a importância da profilaxia relata-se o caso de um paciente sem baço, o qual foi tratado para a neurocisticercose manifestada por epilepsia. Em vinte anos de seguimento, o paciente não repetiu a ocorrência de neurocisticercose, apesar de dano imunológico (ausência de baço) e exposição ambiental (habitação em área endêmica). A prevenção foi guiada pelo uso regular de anti-helmíntico (Albendazole) e medidas educativas em saúde.

Colocalización de proteínas proepileptogénicas en sinapsis hipocampales después de convulsiones / Colocalization of proepileptogenic proteins on hippocampal sinapsis after seizure

INTRODUCCIÓN: La epilepsia del lóbulo temporal se desarrolla como consecuencia de insultos cerebrales como trauma, infartos, infección o convulsiones. Los circuitos neuronales del lóbulo temporal, incluyendo al hipocampo, se reorganizan generando redes hiperexcitables, el foco epiléptico, proceso denominado epileptogénesis; en cambio, la corteza cerebral es más resistente a la reorganización. La epileptogénesis en el hipocampo está mediada en parte por óxido nítrico, sintetizado por la óxido nítrico sintasa neuronal y por la neurotrofina BDNF, cuyo receptor es TrkB. Estas proteínas están localizadas en las sinapsis excitadoras y podrían estar implicadas en la sensibilidad diferencial entre el hipocampo y corteza cerebral a la epileptogénesis. OBJETIVO: Lograr un acercamiento a los mecanismos que participan en la sensibilidad diferencial a la epileptogénesis entre el hipocampo y la corteza, después de convulsiones. MATERIAL Y MÉTODO: Se indujeron convulsiones en ratas mediante inyección de kainato. Se obtuvieron membranas sinápticas reselladas (sinaptosomas) de corteza e hipocampo. En ellas, se cuantificó la co-localización de óxido nítrico sintasa neuronal, TrkB y un marcador de sinapsis excitadoras (Prosap2) mediante técnicas inmunohistoquímicas. Los resultados expresados como por ciento promedio +/- error estándar se sometieron a prueba de t-student. RESULTADOS: TrkB y óxido nítrico sintasa neuronal aumentaron de 20,6 +/- 3,5 por ciento a 35,7 +/- 2,6 por ciento (p = 0,0008) y de 32,4 +/- 3,8 por ciento a 51,5 +/- 3,5 por ciento (p = 0,0003), respectivamente, en sinaptosomas excitadores hipocampales después de convulsiones. En sinaptosomas excitadoras de cerebro corteza no se observaron cambios significativos. DISCUSIÓN: óxido nítrico sintasa neuronal y TrkB se asocian a sinapsis excitadoras hipocampales después de convulsiones, pudiendo contribuir así a la epileptogénesis. La cerebrocorteza es resistente a esta reorganización molecular.

INTRODUCTION: Temporal lobe epilepsy develops as a consequence of brain insults such as trauma, stroke, infection, or seizures. The temporal lobe circuit, including the hippocampus, reorganizes generating hyper-excitable networks and, therefore, the epileptic focus, process called epileptogenesis. Where as, the cerebral cortex is more resistant to the reorganization. Temporal lobe epileptogenesis is mediated partly by neuronal nitric oxide synthase and the neurotrophin BDNF with its receptor TrkB. These proteins are localized at excitatory synapses and might be involved in the differential sensitivity of the hippocampus and cerebral cortex to epileptogenesis. OBJECTIVE: Getting closer to mechanisms involved in epileptogenesis differential sensitivity between the hippocampus and cortex after seizures. MATERIAL AND METHOD: Seizures were induced in rats by injection of kainic acid. Resealed synaptic membranes (synaptosomes) were obtained from cortex and hippocampus. Then the co-localization of neuronal nitric oxide synthase, TrkB and a marker of excitatory synapses (Prosap2/Shank3) was quantified by immunohistochemistry. The results were expressed as mean +/- standard error and subjected to t-student test. RESULTS: TrkB and neuronal nitric oxide synthase increased from 20.6 +/- 3.5 percent to 35.7 +/- 2.6 percent (p = 0.0008) and from 32.4 +/- 3.8 percent to 51.5 +/- 3.5 percent (p = 0.0003), respectively in excitatory hippocampal synaptosomes after seizures. In excitatory cerebrocortical synaptosomes no significant changes were observed. DISCUSSION: neuronal nitric oxide synthase and TrkB associate to excitatory hippocampal synapses after seizures, thereby probably contributing to epileptogenesis. The cerebral cortex is resistant to this molecular reorganization.

Efeito antioxidante da buspirona no modelo de epilepsia induzida por pilocarpina / Antioxidant effect of buspirone in epilepsy model induced by pilocarpine

CONTEXTO: Crises epilépticas induzidas por pilocarpina podem produzir alterações histopatológicas em muitas regiões cerebrais como consequência da produção excessiva de radicais livres.OBJETIVO: O objetivo do presente estudo foi avaliar o efeito antioxidante da buspirona no modelo de epilepsia induzida por pilocarpina.MATERIAL E MÉTODOS: Quarenta e oito animais foram divididos em quatro grupos. O primeiro grupo foi tratado com solução salina 0,9% (Controle). O segundo grupo foi tratado com pilocarpina 400 mg/kg (P400). Por sua vez, o terceiro grupo foi tratado com buspirona 5 mg/kg (BUSP) durante 14 dias consecutivos. Já os animais do quarto grupo foram tratados com buspirona durante 14 dias consecutivos, e, 30 minutos após a última administração dela, os camundongos receberam P400 (BUSP + P400).RESULTADOS: Durante o período do tratamento não se observaram sinais de toxicidade e nenhuma morte entre os animais tratados com buspirona. Em nosso estudo o grupo tratado com P400 demonstrou um aumento significativo da produção de nitrito e nos níveis de peroxidação lipídica após as crises epilépticas. Por outro lado, no hipocampo dos animais que receberam o pré-tratamento com buspirona e após 30 minutos receberam P400, foi observada redução significativa nos níveis de peroxidação lipídica (65%) e nitrito (85%), bem como aumento na atividade da enzima superóxido dismutase.CONCLUSÃO: O pré-tratamento com BUSP aumentou a latência para primeira crise epiléptica e diminuiu a taxa de mortalidade e o número de animais que apresentaram crise epiléptica e que progridem para o estado de mal epiléptico. Além disso, apresentou efeitos anticonvulsivantes associados com a redução do estresse oxidativo hipocampal no modelo de epilepsia induzida por pilocarpina.

BACKGROUND: Pilocarpine-induced seizures can cause pathological changes in many brain regions as a result of excessive production of free radicals.OBJECTIVE: The objective of this study was to evaluate the antioxidant effect of buspirone in the epilepsy model induced by pilocarpine.MATERIAL AND METHODS: Forty-eight animals were divided into four groups. The first group was treated with saline 0.9% (control); the second group received pilocarpine 400 mg/kg (P400); the third group was treated with buspirone 5 mg/kg (BUSP) for 14 consecutive days and animals in the fourth group were treated with buspirone for 14 consecutive days, and 30 minutes after the last buspirone administration were administered with P400 (BUSP + P400).RESULTS: No toxicity signs or death were observed in buspirone-treated animals. P400 group showed a significant increase in nitrite production and lipid peroxidation after seizures. Moreover, reduction in both the lipid peroxidation level (65%) and nitrite content (85%) as well as an increase in superoxide dismutase activity was detected following P400 injection in the hippocampus of buspirone-pretreated mice.DISCUSSION: Pretreatment with BUSP increased latency to first seizure, decreased the mortality rate and number of animals that presented seizures and progression to status epilepticus, showing potent anticonvulsant effects associated with reduction of hippocampal oxidative stress.

Neuronal damage and memory deficits after seizures are reversed by ascorbic acid? / O dano neuronal e o déficit de memória após convulsões são revertidos pelo ácido ascórbico?

The objective of the present study was to evaluate the neuroprotective effects of ascorbic acid (AA) in rats, against the neuronal damage and memory deficit caused by seizures. Wistar rats were treated with 0.9 percent saline (i.p., control group), ascorbic acid (500 mg/kg, i.p., AA group), pilocarpine (400 mg/kg, i.p., pilocarpine group), and the association of ascorbic acid (500 mg/kg, i.p.) plus pilocarpine (400 mg/kg, i.p.), 30 min before of administration of ascorbic acid (AA plus pilocarpine group). After the treatments all groups were observed for 24 h. Pilocarpine group presented seizures which progressed to status epilepticus in 75 percent of the animals. Pretreatment with AA led to a reduction of 50 percent of this rate. Results showed that pretreatment with AA did not alter reference memory when compared to a control group. In the working memory task, we observed a significant day's effect with important differences between control, pilocarpine and AA plus pilocarpine groups. Pilocarpine and AA plus pilocarpine groups had 81 and 16 percent of animals with brain injury, respectively. In the hippocampus of pilocarpine animals, it was detected an injury of 60 percent. As for the animals tested with AA plus pilocarpine, the hippocampal region of the group had a reduction of 43 percent in hippocampal lesion. Our findings suggest that seizures caused cognitive dysfunction and neuronal damage that might be related, at least in part, to the neurological problems presented by epileptic patients. AA can reverse cognitive dysfunction observed in rats with seizures as well as decrease neuronal injury in rat hippocampus.

O objetivo do presente estudo foi avaliar o efeito neuroprotetor do ácido ascórbico (AA), contra o dano neuronal e o déficit de memória em ratos causados pelas convulsões. Ratos Wistar foram tratados com solução salina a 0,9 por cento (i.p., grupo controle), ácido ascórbico (500 mg/kg, i.p., grupo AA), pilocarpina (400 mg/kg, i.p., grupo pilocarpina), e a associação de ácido ascórbico (500 mg/kg, i.p.) com pilocarpina (400 mg/kg, i.p.), 30 min após a administração de ácido ascórbico (AA + pilocarpina grupo). Após os tratamentos todos os grupos foram observados durante 24 h. O grupo pilocarpina apresentou crises convulsivas que evoluíram para o estado de mal epiléptico em 75 por cento dos animais. O pré-tratamento com AA produz uma redução de 50 por cento nesta taxa. Os resultados mostraram que o pré-tratamento com AA não alterou a memória em relação ao controle. No teste de memória, observou-se um efeito significativo nos dias avaliados entre os grupos controle, pilocarpina e AA + pilocarpina. 81 e 16 por cento dos animais dos grupos AA + pilocarpina e pilocarpina apresentaram danos cerebrais, respectivamente. No hipocampo dos animais do grupo pilocarpina, que foi detectada uma lesão de hipocampal de 60 por cento. Quanto aos animais do grupo AA + pilocarpina, a região do hipocampo apresentou uma redução de 43 por cento na extensão da lesão no hippocampo. Nosso resultados sugerem que as convulsões produzem disfunção cognitiva e dano neuronal que podem estar relacionados, pelo menos em parte, aos problemas neurológicos apresentados pelos pacientes epilépticos. O ácido ascórbico pode reverter essa disfunção cognitiva observado em ratos convulsivos, bem como reduz o desenvolvimento da lesão neuronal no hipocampo de ratos.

Avaliação de parâmetros cardíacos em animais com epilepsia: possível causa de morte súbita? / Analysis of cardiac parameters in animals with epilepsy: possible cause of sudden death?

Dentre as causas de morte súbita nas epilepsias (SUDEPE), as disfunções cardíacas têm sido uma área de interesse. Sendo assim, o objetivo de nosso estudo foi avaliar a freqüência cardíaca (FC) (in vivo e in vitro) e a pressão ventricular (PV) in vitro de ratos com epilepsia induzida pela pilocarpina. Ratos machos, adultos, da raça Wistar (n=6) receberam pilocarpina para a indução do status epilepticus. Ratos controles (n=6) receberam solução salina ao invés de pilocarpina. Nossos resultados mostram diferenças significantes na freqüência cardíaca in vivo entre os grupos estudados. Em contraste, não encontramos diferenças entre os grupos nos experimentos in vitro. Nossos resultados sugerem que sob a influência do sistema nervoso central, o coração pode apresentar alterações funcionais que aumentam a probabilidade de ocorrência de morte súbita nas epilepsias.

Three cases of recurrent epileptic seizures caused by Endosulfan.

To commit suicide, three young adults swallowed a relatively small amount of a widely used insecticide containing endosulfan. They developed recurrent epileptic seizures. After hospitalization they were treated and recovered without any sequel. These seizures were classified as acute symptomatic or provoked seizures. We suggest that if one faces acute repetitive seizures, especially in the rural areas, an intoxication such as endosulfan intoxication should be considered when the etiology is uncertain even in the absence of any signs of intoxication.

Epileptic manifestations induced by midazolam in the neonatal period

Antiepileptic drugs may cause worsening of epilepsy by aggravating pre-existing seizures or by triggering new seizure types. There are several reports of adverse effects related to midazolam, but only a few authors reported epileptic manifestations. We report four newborns seen at the Neonatal Intensive Care Unit of our University Hospital, who developed seizures a few seconds after the administration of midazolam. It is difficult to identify the patients at risk, but it is important to be aware and recognize this situation

Electroencephalographic study of iron-induced chronic focal cortical epilepsy in rat: propagation of cortical epileptic activity to substantia nigra and thalamus.

Cortical epileptic focus was produced by an intracortical injection of FeCl3 in rat cerebral cortex using standard techniques. How after its onset in the cortical focus, the epileptiform activity evolved with time in the thalamus and substantia nigra has been determined. To study the propagation of the epileptiform activity, the local EEG and multiple unit action potentials were recorded from these structures simultaneously with the cortical epileptiform EEG. The results showed that in thalamus and substantia nigra epileptiform activity appeared simultaneously with that in the cortical focus. Intensity of epileptic activity in thalamus and substantia nigra on the whole increased in parallel with that in the cortical focus. The results suggest that the thalamic and nigral epileptiform activity may reinforce the cortical epileptiform activity.

Actividad de la Indigofera suffruticosa Mill en la epilepsia crónica experimental y su relación con aminoácidos neurotransmisores / Activity of Indigofera suffruticosa Mill in experimental chronic epilepsy and its relation to neurotransmitter amino acids

Se determinaron los niveles de aminoácidos plasmáticos en el modelo de epilepsia experimental kindling inducido por lidocaína. Se ensayaron 5 grupos: un grupo de animales sin tratamiento, otro de animales kindleados, otro de animales kindleados al que se le suministró el menstruo y los 2 últimos grupos a los cuales se les adminitró por vía oral la dosis de 0.06 g/kg pc del extracto fluido de la planta Indigofera suffructicosa (añil cimarrón), en un grupo durante el tratamiento y en otro antes y durante el tratamiento en el desarrollo del modelo. Los niveles de aminoácidos, taurina, glicina, tirosina, fenilalanina, ácido glutámico y triptófano fueron cuantificados en un analizador de aminoácidos, y se encontró diferencias significativas (p < 0.05) en al ácido glutámico, taurina y glicina en los animales tratados con respecto a los controles. Se realizaron mediciones conductuales a lo largo de la experiencia

The superior colliculus, a neuronal network resistant to the Gaba withdrawal syndrome

Chronic intracortical perfusion of GABA (Gamma Amino Butyric Acid) and its subsequent withdrawal generates, the GABA withdrawal syndrome (GWS). This particular epileptic model has been observed in the motor cortex of monkeys and rats. Our purpose was to study the GWS in the motor cortex (MC), dorsal hippocampus (DH), and superior colliculus (CS). Thirty chronically-implanted adult Wistar rats were separeted into 3 groups of 10 (8 experimental and 2 controls). The first group received GABA in MC, the second in the DH and the third in the SC. GABA was released in doses of 10 to 60 mug/mul/h for 6 days employing osmotic mini-pumps. Two control rats per group received saline solution in the above-mentioned structures. Rats perfused in the MC showed GWS after interruption of the GABA flow. The group perfused in the DH showed paroxysmal discharges and epileptic seizures during perfusion. They also later showed GWS. No epileptic effects were observed in the SC-perfused group during either the GABA perfusion or during withdrawal. None of the six control animals showed epileptic effects. Our results show that the SC offers a strong resistance to GWS. This could be explained by the particular neuronal network structure of rat SC.

Effects of diazepam on fentanyl-induced epileptoid EGG activity and increase of multineuronal firing in limbic and mesencephalic brain structures

Electroencephalographic and clinical signs of epileptoid activity have been associated with the administration offentanyl during surgery in patients. These phenomena have been in turn related to changes in metabolic rate, oxygen consumption, and blood flow in specific brain structures both in humans and experimental animals. However, direct evidence showing changes in neuronal firing in specific brain regions during fentanyl-induced epileptoid activity has not been reported. Eight adult male cats with chronically implanted bipolar electrodes in the mesencephalic reticular formation, hippocampus, amygdala, and parieto-occipital cortex were included in the study. Different treatments i.e., vehicle-fentanyl or diazepam-fentanyl, were administered to the experimental animals at 7-day intervals under neuromuscular blockade and assisted ventilation. Electroencephalographic (EEG) seizures, grouped and isolated spikes, and significant increases of multineuronal activity (MUA) were elicited by fentanyl, 50 µg/kg iv, in these brain structures. Both EEG and MUA changes reached their maximal values within 6 min of fentanyl administration, and then diminished as time elapsed. Diazepam, 100, 200, or 400 µg/kg, but not 50 µg/kg iv, significantly reduced or prevented the fentanyl-induced epileptoid EEG activity and MUA increases. The present results show that both entanyl- induced epileptoid EEGactivity as wel as the concomitant increase in MUA of brain subcortical structures are part of the same epileptogenic phenomenon, mainly generated at limbic structures. In addition, the effects of fiazepamagainst both epileptoid EEG activity and increase of MUA of brain subcortical structures support the use of benzodiazepine as premedicants for fentanyl anesthesia in order to prevent or to reduce epileptoid phenomena that can results from opioid administration during the anesthetic procedures

Effect of cerebellar stimulation on EEG power spectra in the acute model of epilepsy.

Experiments were performed to investigate the effects of cerebellar stimulation on epilepsy induced by parenteral administration of penicillin, in rats without or with the lesion of sensorimotor cortex. There were no differences in the EEG activity of the same experimental animal after the first and subsequent penicillin treatments (at least 7 days later). The electrical stimulation (duration of 5-10 min) of the lateral cerebellar nucleus was applied repetitively 135-315 min after penicillin administration, when the EEG power spectra markedly increased. The cerebellar stimulation evoked the decrease of the mean total EEG power spectra, but the effects were temporary. The EEG power spectra were significantly lower (P < 0.05) during the period of 150-330 min after penicillin treatment in experimental sessions with applied cerebellar stimulation in comparison to the experimental sessions without such stimulation. The residual effects (if any) of cerebellar stimulation on the EEG activity in the later period, 345-600 after penicillin treatment were not significant (P > 0.05). Cerebellar stimulation had the same effect among unlesioned animals and animals with prior cortical lesion in the acute model of epilepsy.

Lupus eritematoso sistêmico (LES) induzido por carbamazepina (CBZ): relato de caso / Systemic lupus erythematosus (LES) induced by carbamazepine (CBZ): repor a case

C. M. M. A., 32 a., fem, bca, severo atraso no desenvolvimento neuropsicomotor desde o nascimento. Iniciou, aos 13 anos, crises parciais complexas com ou sem generalizaçäo secundária. Foi submetida a vários esquemas medicamentosos sem controle completo das crises. Com a introduçäo de CBZ em 05/88, houve evidente reduçäo da frequência das crises. Em 11/89 passou a apresentar apatia, febre, emagrecimento (13 kg em 4 meses), náuseas, vômitos, rash malar e artrite de tornozelos. Laboratorialmente, o hemograma mostrou anemia miocrítica, Hb=9.8, Ht=31, VHS=100mm, células LE: 40 por cento , fator antinúcleo (FAN) = 10240 padräo periférico e homogêneo, anti SM-RNP-PO-LA-DNA negtivos; RX tórax mostrou finas áreas de atelectasia na base pulmonar direita. Com estes elementos, foi feito o diagnóstico de LES induzido por CBZ e introduzido 20mg de predinisona, com retirada lenta e gradual em 7 meses. Substituído a CBZ por valproato de sódio (VA), houve piora das crises, porém com desaparecimento da sintomatologia e normalizaçäo das provas laboratoriais, exceto a manutençäo da positividade do FAN, com títulos baixos (1:2560 - 05/91). Ressaltamos a importância de investigaçäo laboratorial para LES, em pacientes em uso de drogas antiepilépticas com manifestaçöes sistêmicas, particularmente em pacientes com retardo mental severo, cujos dados clínicos podem näo ser confiáveis. A evoluçäo favorável, na ausência de tratamento específico, e diminuiçäo significativa do FAN, após a suspensäo da CBZ, sugerem tratar-se de LES induzido por droga