Structural changes for adult-born dentate granule cells after status epilepticus

A seizure attributed to ofloxacine in a woman undergoing detoxification for alcohol dependence

Objective. To report one case of seizure following administration of ofloxacin. Case Summary. A 38-year-old woman with alcohol dependence but no prior history of seizure disorder admitted in our inpatient alcohol detoxification program was prescribed ofloxacin four days after admission for a lower urinary tract infection. She was currently prescribed diazepam 30 mg per day. This treatment was continued without modification following admission. Forty eight hours after starting ofloxacin and after receiving five doses of oral ofloxacin, the patient experienced a seizure. Ofloxacin treatment was stopped and no further seizures occurred. Neurological examination of the patient, laboratory tests, computerized tomography with contrast enhancement and electroencephalography did not detect any abnormalities. Up to the last consultation, six months after admission, the patient has reported no recurrence of the seizure. Discussion. Quinolone antibiotics vary in their ability to induce seizures, with ofloxacin having one of the least potentials. In the present case, the seizure could be attributed in all probability to taking ofloxacin; since she had no previous history of seizures, she did not present an alcohol withdrawal syndrome, benzodiazepine treatment was not modified, the seizure occurred 48 h after taking ofloxacin, but seven days after stopping drinking, no alternative aetiologies for the seizure could be identified and no seizure recurrence was reported over the following seven months. Of reported cases of seizures in patients treated with fluoroquinolones, none concerned patients with alcohol dependence or patients treated with benzodiazepines. Conclusions. The present case alerts us to the possibility that seizures may occur in alcohol dependent patients treated with benzodiazepines who concomitantly prescribed a fluoroquinolone. These widely-used antibiotics should thus be prescribed with caution to patients undergoing detoxification for alcohol dependence, particularly if they are also taking benzodiazepines, irrespective of whether they have a previous history of seizures or not.

Effects of lamotrigine and topiramate on hippocampal neurogenesis in experimental temporal-lobe epilepsy

Lamotrigine (LTG) and topiramate (TPM), two of the most commonly used new-generation antiepileptic drugs (AEDs), have been shown to produce no adverse and impaired cognitive effects in patients with epilepsy, respectively. As seizure-induced neurogenesis might contribute to cognitive deficits that are associated with status epilepticus (SE), we examined whether these two drugs produce differential effects on seizure-induced neurogenesis in the hippocampus of adult rats. Lithium pilocarpine model was used to mimic human temporal-lobe epilepsy. Five hours after SE, LTG and TPM were administered intragastrically twice daily throughout the entire length of the experiment with total daily dose of 20 and 80 mg/kg, respectively. The hippocampal neurogenesis was examined using 5-bromodeoxyuridine and doublecortin immunohistochemistry. Both LTG and TPM treatments significantly inhibited seizure-induced proliferation of neural progenitors in the hippocampus, but did not affect the neuronal differentiation of newborn cells. Long-term treatment with both AEDs decreased the number of spontaneous recurrent seizures after SE and alleviated chronic seizure-induced neuronal injury in the dentate hilus. Eventually, TPM significantly increased the number of newborn neurons in the dentate granular cell layer after seizures likely by promoting the survival of newborn neurons. In contrast, LTG treatment significantly reduced the number of ectopic hilar newborn neurons after seizures. Neither of them prevented the formation of hilar basal dendrites of newborn neurons in the epileptic hippocampus. These results indicate that TPM but not LTG promotes aberrant neuron regeneration in the hippocampus after SE, which might be partially related to their differential effects on cognitive function.

Postnatal neurogenesis as a therapeutic target in temporal lobe epilepsy

After it was first identified that seizures increase neurogenesis in the adult brain of laboratory animals, the idea that postnatal neurogenesis may be involved in epilepsy became a topic of widespread interest. Since that time, two perspectives have developed. They primarily address temporal lobe epilepsy (TLE), because the data have either been based on animal models of TLE or patients with intractable TLE. The first perspective is that postnatal neurogenesis contributes to the predisposition for seizures in TLE. This premise is founded in the observations showing that there is a dramatic rise in neurogenesis after many types of insults or injuries which ultimately lead to TLE. As a result of the increase in neurogenesis, several changes in the dentate gyrus occur, and the net effect appears to be an increase in excitability. One of the changes is the formation of a population of granule cells (GCs) that mismigrate, leading to ectopic granule cells in the hilus (hilar EGCs) that exhibit periodic bursts of action potentials, and contribute to recurrent excitatory circuitry. Atypical dendrites also form on a subset of GCs, and project into the hilus (hilar basal dendrites). Hilar basal dendrites appear to preferentially increase the glutamatergic input relative to GABAergic synapses, increasing excitability of the subset of GCs that form hilar basal dendrites. The alternate view is that postnatal neurogenesis is a homeostatic mechanism in epilepsy that maintains normal excitability. This idea is supported by studies showing that some of the new GCs that are born after seizures, and migrate into the correct location, have normal or reduced excitability. Here we suggest that both perspectives may be important when considering a therapeutic strategy. It would seem advantageous to limit the numbers of mismigrating GCs and hilar basal dendrites, but maintain normal neurogenesis because it is potentially homeostatic. Maintaining normal neurogenesis is also important because it has been suggested that a decrease in dentate gyrus neurogenesis contributes to depression. It is challenging to design a strategy that would achieve these goals, and it is also difficult to propose how one could administer such a therapy prophylactically, that is, as an "antiepileptogenic" approach. Another issue to address is how a therapeutic intervention with these goals could be successful if it were administered after chronic seizures develop, when most patients seek therapy. Although difficult, a number of approaches are possible, and technical advances suggest that there are more on the horizon.

Dentate granule cells form hilar basal dendrites in a rat model of hypoxia-ischemia

Hilar basal dendrites form on dentate granule cells following seizures. To determine whether other brain insults cause the formation of hilar basal dendrites, a model of global cerebral hypoxia/ischemia was used. Rats underwent a transient induction of ischemia by occlusion of both common carotid arteries followed by reperfusion. Hippocampal slices were prepared from these animals 1 month after the ischemic insult, and granule cells were labeled with a retrograde tracing technique after biocytin injections into stratum lucidum of CA3b. Ischemic rats had numerous biocytin-labeled granule cells with hilar basal dendrites located at the hilar border of the granule cell layer. Quantitative analysis of ischemic rats compared to controls showed a significant increase in the percentage of biocytin-labeled granule cells with hilar basal dendrites. These data demonstrate that other brain insults in addition to epilepsy may result in the formation of hilar basal dendrites on granule cells.

Partial kindling induces neurogenesis, activates astrocytes and alters synaptic morphology in the dentate gyrus of freely moving adult rats

A partial kindling procedure was used to investigate the correlation between focal seizure development and changes in dendritic spine morphology, ongoing neurogenesis and reactive astrogliosis in the adult rat dentate gyrus (DG). The processes of neurogenesis and astrogliosis were investigated using markers for doublecortin (DCX), 5-bromo-2-deoxyuridine (BrdU) and glial fibrillary acidic protein (GFAP). Our data demonstrate that mild focal seizures induce a complex series of cellular events in the DG one day after cessation of partial rapid kindling stimulation consisting (in comparison to control animals that were electrode implanted but unkindled), firstly, of an increase in the number of postmitotic BrdU labeled cells, and secondly, an increase in the number of DCX labeled cells, mainly in subgranular zone. Ultrastructural changes were examined using qualitative electron microscope analysis and 3-D reconstructions of both dendritic spines and postsynaptic densities. Typical features of kindling in comparison to control tissue included translocation of mitochondria to the base of the dendritic spine stalks; a migration of multivesicular bodies into mushroom dendritic spines, and most notably formation of "giant" spinules originating from the head of the spines of DG neurons. These morphological alterations arise at seizure stages 2-3 (focal seizures) in the absence of signs of the severe generalized seizures that are generally recognized as potentially harmful for neuronal cells. We suggest that an increase in ongoing neurogenesis, reactive astrogliosis and dendritic spine reorganization in the DG is the crucial step in the chain of events leading to the progressive development of seizure susceptibility in hippocampal circuits.