Human epileptic brain Na, K ATPase activity and phenytoin concentrations

Na+/K+-ATPase: ion pump, signal transducer, or cytoprotective protein, and novel biological functions

Na+/K+-ATPase is a transmembrane protein that has important roles in the maintenance of electrochemical gradients across cell membranes by transporting three Na+ out of and two K+ into cells. Additionally, Na+/K+-ATPase participates in Ca2+-signaling transduction and neurotransmitter release by coordinating the ion concentration gradient across the cell membrane. Na+/K+-ATPase works synergistically with multiple ion channels in the cell membrane to form a dynamic network of ion homeostatic regulation and affects cellular communication by regulating chemical signals and the ion balance among different types of cells. Therefore, it is not surprising that Na+/K+-ATPase dysfunction has emerged as a risk factor for a variety of neurological diseases. However, published studies have so far only elucidated the important roles of Na+/K+-ATPase dysfunction in disease development, and we are lacking detailed mechanisms to clarify how Na+/K+-ATPase affects cell function. Our recent studies revealed that membrane loss of Na+/K+-ATPase is a key mechanism in many neurological disorders, particularly stroke and Parkinson's disease. Stabilization of plasma membrane Na+/K+-ATPase with an antibody is a novel strategy to treat these diseases. For this reason, Na+/K+-ATPase acts not only as a simple ion pump but also as a sensor/regulator or cytoprotective protein, participating in signal transduction such as neuronal autophagy and apoptosis, and glial cell migration. Thus, the present review attempts to summarize the novel biological functions of Na+/K+-ATPase and Na+/K+-ATPase-related pathogenesis. The potential for novel strategies to treat Na+/K+-ATPase-related brain diseases will also be discussed.

Combined Treatment of Dichloroacetic Acid and Pyruvate Increased Neuronal Survival after Seizure

During seizure activity, glucose and Adenosine triphosphate (ATP) levels are significantly decreased in the brain, which is a contributing factor to seizure-induced neuronal death. Dichloroacetic acid (DCA) has been shown to prevent cell death. DCA is also known to be involved in adenosine triphosphate (ATP) production by activating pyruvate dehydrogenase (PDH), a gatekeeper of glucose oxidation, as a pyruvate dehydrogenase kinase (PDK) inhibitor. To confirm these findings, in this study, rats were given a per oral (P.O.) injection of DCA (100 mg/kg) with pyruvate (50 mg/kg) once per day for 1 week starting 2 h after the onset of seizures induced by pilocarpine administration. Neuronal death and oxidative stress were assessed 1 week after seizure to determine if the combined treatment of pyruvate and DCA increased neuronal survival and reduced oxidative damage in the hippocampus. We found that the combined treatment of pyruvate and DCA showed protective effects against seizure-associated hippocampal neuronal cell death compared to the vehicle-treated group. Treatment with combined pyruvate and DCA after seizure may have a therapeutic effect by increasing the proportion of pyruvate converted to ATP. Thus, the current research demonstrates that the combined treatment of pyruvate and DCA may have therapeutic potential in seizure-induced neuronal death.

Start Me Up: How Can Surrounding Gangliosides Affect Sodium-Potassium ATPase Activity and Steer towards Pathological Ion Imbalance in Neurons?

Gangliosides, amphiphilic glycosphingolipids, tend to associate laterally with other membrane constituents and undergo extensive interactions with membrane proteins in cis or trans configurations. Studies of human diseases resulting from mutations in the ganglioside biosynthesis pathway and research on transgenic mice with the same mutations implicate gangliosides in the pathogenesis of epilepsy. Gangliosides are reported to affect the activity of the Na⁺/K⁺-ATPase, the ubiquitously expressed plasma membrane pump responsible for the stabilization of the resting membrane potential by hyperpolarization, firing up the action potential and ion homeostasis. Impaired Na⁺/K⁺-ATPase activity has also been hypothesized to cause seizures by several mechanisms. In this review we present different epileptic phenotypes that are caused by impaired activity of Na⁺/K⁺-ATPase or changed membrane ganglioside composition. We further discuss how gangliosides may influence Na⁺/K⁺-ATPase activity by acting as lipid sorting machinery providing the optimal stage for Na⁺/K⁺-ATPase function. By establishing a distinct lipid environment, together with other membrane lipids, gangliosides possibly modulate Na⁺/K⁺-ATPase activity and aid in “starting up” and “turning off” this vital pump. Therefore, structural changes of neuronal membranes caused by altered ganglioside composition can be a contributing factor leading to aberrant Na⁺/K⁺-ATPase activity and ion imbalance priming neurons for pathological firing.

The role of Na+ -K+ -ATPase in the epileptic brain

Na+-K+-ATPase, a P-type ATP-powered ion transporter on cell membrane, plays a vital role in cellular excitability. Cellular hyperexcitability, accompanied by hypersynchronous firing, is an important basis for seizures/epilepsy. An increasing number of studies point to a significant contribution of Na+-K+-ATPase to epilepsy, although discordant results exist. In this review, we comprehensively summarize the structure and physiological function of Na+-K+-ATPase in the central nervous system and critically evaluate the role of Na+-K+-ATPase in the epileptic brain. Importantly, we further provide perspectives on some possible research directions and discuss its potential as a therapeutic target for the treatment of epilepsy.

Fluoride Exposure Induces Inhibition of Sodium-and Potassium-Activated Adenosine Triphosphatase (Na+, K+-ATPase) Enzyme Activity: Molecular Mechanisms and Implications for Public Health

In this study, several lines of evidence are provided to show that Na + , K + -ATPase activity exerts vital roles in normal brain development and function and that loss of enzyme activity is implicated in neurodevelopmental, neuropsychiatric and neurodegenerative disorders, as well as increased risk of cancer, metabolic, pulmonary and cardiovascular disease. Evidence is presented to show that fluoride (F) inhibits Na + , K + -ATPase activity by altering biological pathways through modifying the expression of genes and the activity of glycolytic enzymes, metalloenzymes, hormones, proteins, neuropeptides and cytokines, as well as biological interface interactions that rely on the bioavailability of chemical elements magnesium and manganese to modulate ATP and Na + , K + -ATPase enzyme activity. Taken together, the findings of this study provide unprecedented insights into the molecular mechanisms and biological pathways by which F inhibits Na + , K + -ATPase activity and contributes to the etiology and pathophysiology of diseases associated with impairment of this essential enzyme. Moreover, the findings of this study further suggest that there are windows of susceptibility over the life course where chronic F exposure in pregnancy and early infancy may impair Na + , K + -ATPase activity with both short- and long-term implications for disease and inequalities in health. These findings would warrant considerable attention and potential intervention, not to mention additional research on the potential effects of F intake in contributing to chronic disease.

Distribution of Anticonvulsant Drugs in Gray and White Matter of Human Brain

Gray and white matter were obtained during neurosurgical therapy of focal epilepsy from 17 patients. In 10 patients, receiving only phenobarbital, the drug was uniformly distributed between gray and white matter. Phenytoin concentrations averaged 1.4-fold greater in white matter than in gray matter when expressed per gram wet weight of tissue. The gray matter/plasma ratio of phenytoin was approximately 2-fold greater than that of phenobarbital. Carbamazepine levels were also slightly greater in white matter The data revealed wide differences between drugs in the relative concentrations in gray and white matter, which must be taken into account in any quantitative studies of anticonvulsant drug levels in the brain.

Na+, K+-ATPase Activating Antibody Displays in vitro and in vivo Beneficial Effects in the Pilocarpine Model of Epilepsy

Na⁺, K⁺-ATPase is an important regulator of brain excitability. Accordingly, compelling evidence indicates that impairment of Na⁺, K⁺-ATPase activity contributes to seizure activity in epileptic mice and human with epilepsy. In addition, this enzyme is crucial for plasma membrane transport of water, glucose and several chemical mediators, including glutamate, the major excitatory transmitter in the mammalian brain. Since glucose hypometabolism and increased glutamate levels occur in clinical and experimental epilepsy, we aimed the present study to investigate whether activation of Na⁺, K⁺-ATPase activity with specific antibody (DRRSAb) would improve glucose uptake and glutamate release in pilocarpine-treated mice. We found decreased uptake of the glucose fluorescent analog 2-[N-(7-nitrobenz-2-oxa-1,3-diazol-4-il)amino]-2-desoxi-d-glucose (2-NBDG) in cerebral slices from pilocarpine-treated animals. Interestingly, decreased 2-NBDG uptake was not detected in DRRSAb-treated slices, suggesting a protective effect of the Na⁺, K⁺-ATPase activator. Moreover, DRRSAb prevented the increase in glutamate levels in the incubation media of slices from pilocarpine-treated mice. In addition, in vivo intrahippocampal injection of DRRSAb restored crossing activity of pilocarpine-treated mice in the open-field test. Overall, the present data further support the hypothesis that activation of the Na⁺, K⁺-ATPase is a promising therapeutic strategy for epilepsy.

Cognitive deficits caused by a disease-mutation in the α3 Na(+)/K(+)-ATPase isoform

The Na⁺/K⁺-ATPases maintain Na⁺ and K⁺ electrochemical gradients across the plasma membrane, a prerequisite for electrical excitability and secondary transport in neurons. Autosomal dominant mutations in the human ATP1A3 gene encoding the neuron-specific Na⁺/K⁺-ATPase α₃ isoform cause different neurological diseases, including rapid-onset dystonia-parkinsonism (RDP) and alternating hemiplegia of childhood (AHC) with overlapping symptoms, including hemiplegia, dystonia, ataxia, hyperactivity, epileptic seizures, and cognitive deficits. Position D801 in the α₃ isoform is a mutational hotspot, with the D801N, D801E and D801V mutations causing AHC and the D801Y mutation causing RDP or mild AHC. Despite intensive research, mechanisms underlying these disorders remain largely unknown. To study the genotype-to-phenotype relationship, a heterozygous knock-in mouse harboring the D801Y mutation (α₃^+/D801Y) was generated. The α₃^+/D801Y mice displayed hyperactivity, increased sensitivity to chemically induced epileptic seizures and cognitive deficits. Interestingly, no change in the excitability of CA1 pyramidal neurons in the α₃^+/D801Y mice was observed. The cognitive deficits were rescued by administration of the benzodiazepine, clonazepam, a GABA positive allosteric modulator. Our findings reveal the functional significance of the Na⁺/K⁺-ATPase α₃ isoform in the control of spatial learning and memory and suggest a link to GABA transmission.

Knock-in mouse model of alternating hemiplegia of childhood: behavioral and electrophysiologic characterization

OBJECTIVES

Mutations in the ATP1α3 subunit of the neuronal Na+/K+-ATPase are thought to be responsible for seizures, hemiplegias, and other symptoms of alternating hemiplegia of childhood (AHC). However, the mechanisms through which ATP1A3 mutations mediate their pathophysiologic consequences are not yet understood. The following hypotheses were investigated: (1) Our novel knock-in mouse carrying the most common heterozygous mutation causing AHC (D801N) will exhibit the manifestations of the human condition and display predisposition to seizures; and (2) the underlying pathophysiology in this mouse model involves increased excitability in response to electrical stimulation of Schaffer collaterals and abnormal predisposition to spreading depression (SD).

METHODS

We generated the D801N mutant mouse (Mashlool, Mashl+/-) and compared mutant and wild-type (WT) littermates. Behavioral tests, amygdala kindling, flurothyl-induced seizure threshold, spontaneous recurrent seizures (SRS), and other paroxysmal activities were compared between groups. In vitro electrophysiologic slice experiments on hippocampus were performed to assess predisposition to hyperexcitability and SD.

RESULTS

Mutant mice manifested a distinctive phenotype similar to that of humans with AHC. They had abnormal impulsivity, memory, gait, motor coordination, tremor, motor control, endogenous nociceptive response, paroxysmal hemiplegias, diplegias, dystonias, and SRS, as well as predisposition to kindling, to flurothyl-induced seizures, and to sudden unexpected death. Hippocampal slices of mutants, in contrast to WT animals, showed hyperexcitable responses to 1 Hz pulse-trains of electrical stimuli delivered to the Schaffer collaterals and had significantly longer duration of K+-induced SD responses.

SIGNIFICANCE

Our model reproduces the major characteristics of human AHC, and indicates that ATP1α3 dysfunction results in abnormal short-term plasticity with increased excitability (potential mechanism for seizures) and a predisposition to more severe SD responses (potential mechanism for hemiplegias). This model of the human condition should help in understanding the molecular pathways underlying these phenotypes and may lead to identification of novel therapeutic strategies of ATP1α3 related disorders and seizures.

Long-term decrease in Na+,K+-ATPase activity after pilocarpine-induced status epilepticus is associated with nitration of its alpha subunit

Temporal lobe epilepsy (TLE) is the most common type of epilepsy with about one third of TLE patients being refractory to antiepileptic drugs. Knowledge about the mechanisms underlying seizure activity is fundamental to the discovery of new drug targets. Brain Na(+),K(+)-ATPase activity contributes to the maintenance of the electrochemical gradients underlying neuronal resting and action potentials as well as the uptake and release of neurotransmitters. In the present study we tested the hypothesis that decreased Na(+),K(+)-ATPase activity is associated with changes in the alpha subunit phosphorylation and/or redox state. Activity of Na(+),K(+)-ATPase decreased in the hippocampus of C57BL/6 mice 60 days after pilocarpine-induced status epilepticus (SE). In addition, the Michaelis-Menten constant for ATP of α2/3 isoforms increased at the same time point. Nitration of the α subunit may underlie decreased Na(+),K(+)-ATPase activity, however no changes in expression or phosphorylation state at Ser(943) were found. Further studies are necessary define the potential of nitrated Na(+),K(+)-ATPase as a new therapeutic target for seizure disorders.

Cation-chloride cotransporters NKCC1 and KCC2 as potential targets for novel antiepileptic and antiepileptogenic treatments

In cortical and hippocampal neurons, cation-chloride cotransporters (CCCs) control the reversal potential (EGABA) of GABAA receptor-mediated current and voltage responses and, consequently, they modulate the efficacy of GABAergic inhibition. Two members of the CCC family, KCC2 (the major neuron-specific K-Cl cotransporter; KCC isoform 2) and NKCC1 (the Na-K-2Cl cotransporter isoform 1 which is expressed in both neurons and glial cells) have attracted much interest in studies on GABAergic signaling under both normal and pathophysiological conditions, such as epilepsy. There is tentative evidence that loop diuretic compounds such as furosemide and bumetanide may have clinically relevant antiepileptic actions, especially when administered in combination with conventional GABA-mimetic drugs such as phenobarbital. Furosemide is a non-selective inhibitor of CCCs while at low concentrations bumetanide is selective for NKCCs. Search for novel antiepileptic drugs (AEDs) is highly motivated especially for the treatment of neonatal seizures which are often resistant to, or even aggravated by conventional AEDs. This review shows that the antiepileptic effects of loop diuretics described in the pertinent literature are based on widely heterogeneous mechanisms ranging from actions on both neuronal NKCC1 and KCC2 to modulation of the brain extracellular volume fraction. A promising strategy for the development of novel CCC-blocking AEDs is based on prodrugs that are activated following their passage across the blood-brain barrier. This article is part of the Special Issue entitled 'New Targets and Approaches to the Treatment of Epilepsy'.

Cardiac glycosides ouabain and digoxin interfere with the regulation of glutamate transporter GLAST in astrocytes cultured from neonatal rat brain

Glutamate transport (GluT) in brain is mediated chiefly by two transporters GLT and GLAST, both driven by ionic gradients generated by (Na⁺, K⁺)-dependent ATPase (Na⁺/K⁺-ATPase). GLAST is located in astrocytes and its function is regulated by translocations from cytoplasm to plasma membrane in the presence of GluT substrates. The phenomenon is blocked by a naturally occurring toxin rottlerin. We have recently suggested that rottlerin acts by inhibiting Na⁺/K⁺-ATPase. We now report that Na⁺/K⁺-ATPase inhibitors digoxin and ouabain also blocked the redistribution of GLAST in cultured astrocytes, however, neither of the compounds caused detectable inhibition of ATPase activity in cell-free astrocyte homogenates (rottlerin inhibited app. 80% of Pi production from ATP in the astrocyte homogenates, IC50 = 25 μM). Therefore, while we may not have established a direct link between GLAST regulation and Na⁺/K⁺-ATPase activity we have shown that both ouabain and digoxin can interfere with GluT transport and therefore should be considered potentially neurotoxic.

Differential effects of Na+-K+ ATPase blockade on cortical layer V neurons

Sodium-potassium ATPase ('Na(+)-K(+) ATPase') contributes to the maintenance of the resting membrane potential and the transmembrane gradients for Na(+) and K(+) in neurons. Activation of Na(+)-K(+) ATPase may be important in controlling increases in intracellular sodium during periods of increased neuronal activity. Down-regulation of Na(+)-K(+) ATPase activity is implicated in numerous CNS disorders, including epilepsy. Although Na(+)-K(+) ATPase is present in all neurons, little is known about its activity in different subclasses of neocortical cells. We assessed the physiological properties of Na(+)-K(+) ATPase in fast-spiking (FS) interneurons and pyramidal (PYR) cells to test the hypothesis that Na(+)-K(+) ATPase activity would be relatively greater in neurons that generated high frequency action potentials (the FS cells). Whole-cell patch clamp recordings were made from FS and PYR neurons in layer V of rat sensorimotor cortical slices maintained in vitro using standard techniques. Bath perfusion of Na(+)-K(+) ATPase antagonists (ouabain or dihydro-ouabain) induced either a membrane depolarization in current clamp, or inward current under voltage clamp in both cell types. PYR neurons were divided into two subpopulations based on the amplitude of the voltage or current shift in response to Na(+)-K(+) ATPase blockade. The two PYR cell groups did not differ significantly in electrophysiological properties including resting membrane potential, firing pattern, input resistance and capacitance. Membrane voltage responses of FS cells to Na(+)-K(+) ATPase blockade were intermediate between the two PYR cell groups (P < 0.05). The resting Na(+)-K(+) ATPase current density in FS interneurons, assessed by application of blockers, was 3- to 7-fold larger than in either group of PYR neurons. Na(+)-K(+) ATPase activity was increased either through direct Na(+) loading via the patch pipette or by focal application of glutamate (20 mM puffs). Under these conditions FS interneurons exhibited the largest increase in Na(+)-K(+) ATPase activity. We conclude that resting Na(+)-K(+) ATPase activity and sensitivity to changes in internal Na(+) concentration vary between and within classes of cortical neurons. These differences may have important consequences in pathophysiological disorders associated with down-regulation of Na(+)-K(+) ATPase and hyperexcitability within cortical networks.

The Na+/K+ATPase activity is increased in the hippocampus after multiple status epilepticus induced by pilocarpine in developing rats

The effects of repetitive pilocarpine-induced status epilepticus (SE) in the hippocampal Na(+)/K(+)ATPase activity were studied in developing rat. Na(+)/K(+)ATPase is a membrane-bound enzyme responsible for the active transport of sodium and potassium ions through the membrane. It is necessary to maintain neuronal excitability. The malfunction of this enzyme has been associated with neuronal hyperexcitability. The pilocarpine-induced status epilepticus in developing rats leads to neuronal hyperexcitability and brain damage. We examined the activity of the Na(+)/K(+)ATPase enzyme in hippocampus of rats submitted to 1 episode of status epilepticus on postnatal day 9 and to 3 episodes of pilocarpine-induced status epilepticus on postnatal days 7, 8 and 9. Our findings showed that one status epilepticus episode does not modify the Na(+)/K(+)ATPase activity in hippocampus of rats studied 7 or 30 days later (at P16 or P39). However, an increase in the Na(+)/K(+)ATPase activity was detected in hippocampus of rats submitted to three consecutive status epilepticus during the development studied 7 (+142%) and 30 (+400%) days following the injections. In addition, a significant reduction in the Na(+)/K(+)ATPase activity was observed in control rats at P39 compared to P16. Our data suggest that multiple pilocarpine-induced status epilepticus in developing rats induce long-lasting increase in the Na(+)/K(+)ATPase activity in the hippocampus, reflecting hyperexcitability.

Hypothalamic digoxin-mediated model for epileptogenesis

BACKGROUND/AIMS

This study assessed the changes in the isoprenoid pathway and its metabolites in seizure disorder (ILAE classification - I generalized - idiopathic generalized epilepsy with age-related onset - epilepsy with generalized tonic clonic seizures on awakening) and the metabolic cascade produced by isoprenoid pathway dysregulation.

METHODS

The following parameters were assessed in seizure disorder: isoprenoid pathway metabolites, tyrosine and tryptophan catabolites, glycoconjugates metabolism and red blood cell (RBC) membrane composition.

RESULTS

There was elevation in plasma HMG-CoA reductase activity, serum digoxin and dolichol and a reduction in RBC membrane Na-K+ ATPase activity, serum magnesium and ubiquinone levels. Serum tryptophan, serotonin, strychnine, nicotine and quinolinic acid were elevated while tyrosine, dopamine, morphine and norepinephrine were decreased. The total serum glycosaminoglycans and glycosaminoglycan fractions (except dermatan sulfate), the activity of glycosaminoglycans (GAG) degrading enzymes and glycohydrolases, carbohydrate residues of glycoproteins and serum glycolipids were elevated. Total serum cholesterol, LDL cholesterol and free fatty acids were increased while HDL cholesterol and triglycerides were unaltered. The concentration of membrane hexose, fucose, cholesterol and phospholipids in the RBC membrane decreased significantly but the total RBC membrane GAG was unaltered.

CONCLUSIONS

Epileptogenesis could be due to a dysfunctional isoprenoidal pathway and paroxysmal hypothalamic digoxin hypersecretion.

Hypothalamic digoxin, geomagnetic fields and human disease--a hypothesis

The human hypothalamus synthesis an endogenous membrane Na(+)-K(+) ATPase inhibitor, digoxin. A digoxin-mediated model for quantal perception of geomagnetic fields is proposed. External geomagnetic fields can produce membrane Na(+)-K(+) ATPase inhibition. The inhibition of Na(+)-K(+) ATPase can contribute to increase in intracellular calcium and decrease in magnesium, which can result in (1) defective neurotransmitter transport mechanism, (2) neuronal degeneration and apoptosis, (3) mitochondrial dysfunction, (4) defective golgi body function and protein processing dysfunction, (5) immune dysfunction and oncogenesis. Geomagnetic fields can thus regulate cellular function and contributing to the pathogenesis of disease.

A comparison of extracellular levels of phenytoin in amygdala and hippocampus of kindled and non-kindled rats

Temporal lobe epilepsy is often refractory to antiepileptic drugs (AEDs). Accordingly, amygdala-kindled rats, a widely used model of temporal lobe epilepsy, have previously been found to be less responsive to AED treatment than non-kindled rats. In view of recent findings of over-expression of multidrug transporters in the blood-brain barrier of patients with pharmacoresistant epilepsy, one explanation for the finding of difficult-to-treat seizures in kindled rats would be a reduced penetration of AEDs into epileptogenic brain tissue. For evaluation of this possibility, we used brain microdialysis in order to compare extracellular levels of the AED phenytoin in amygdala and hippocampus of conscious, unrestrained amygdala-kindled and non-kindled rats. Consistent with the lower anticonvulsant efficacy of phenytoin in kindled rats, average phenytoin levels in dialysates of kindled rats were lower (up to 30%) than in non-kindled controls, but the differences were not statistically significant. This indicates that either the relatively large interindividual variation in dialysate levels of phenytoin masks functionally significant differences in individual kindled rats or that alterations in brain drug penetration are not involved in the lowered response of kindled rats to AEDs.

Effects of streptozotocin-induced diabetes and pentylenetetrazol-induced seizure on brain cortex (Ca2+)ATPase activity in rats

The aim of the present study was to obtain information about the effects of pentylenetetrazol-induced status epilepticus (SE) and streptozotocin-induced diabetes on brain cortex Ca(2+)ATPase activity. Treatment with pentylenetetrazol (PTZ) and streptozotocin (STZ) to rats resulted in significant decrease in brain cortex Ca(2+)ATPase activity as compared with controls. However, PTZ-treated diabetic rats had a slight but non-significant decrease in enzyme activity. Treatment with PTZ caused a more pronounced effect in inhibiting enzyme activity than that of treatment with STZ. Our results concluded that reduced brain cortex Ca(2+)ATPase activity following PTZ and STZ treatments to rats, may be an initial biochemical lesion which triggers a sequence of events which may culminate in cell death.

Na+K+ ATPase activity in the rat hippocampus: a study in the pilocarpine model of epilepsy

Biochemical abnormalities have been implicated in possible mechanisms underlying the epileptic phenomena. Some of these alterations include changes in the activity of several enzymes present in epileptic tissues. Systemic administration of pilocarpine in rats induces electrographic and behavioral limbic seizures and status epilepticus, that is followed by a transient seizure-free period (silent period). Finally a chronic phase ensues, characterized by spontaneous and recurrent seizures (chronic period), that last for the rest of the animal's life. The present work aimed to study the activity of the enzyme Na+K+ ATPase, in rat hippocampus, during the three phases of this epilepsy model. The enzyme activity was determined at different time points from pilocarpine administration (1 and 24 h of status epilepticus, during the silent and chronic period) using a spectrophotometric assay previously described by Mishra and Delivoria-Papadopoulos [Neurochem. Res. (1988) 13, 765-770]. The results showed decreased enzyme activities during the acute and silent periods and increased Na+K+ ATPase activity during the chronic phase. These data show that changes in Na+K+ ATPase activity could be involved in the appearance of spontaneous and recurrent seizures following brain damage induced by pilocarpine injection.

Vulnerability of medium spiny striatal neurons to glutamate: role of Na+/K+ ATPase

In Huntington's disease neuronal degeneration mainly involves medium-sized spiny neurons. It has been postulated that both excitotoxic mechanisms and energy metabolism failure are implicated in the neuronal degeneration observed in Huntington's disease. In central neurons, > 40% of the energy released by respiration is used by Na+/K+ ATPase to maintain ionic gradients. Considering that impairment of Na+/K+ ATPase activity might alter postsynaptic responsivity to excitatory amino acids (EAAs), we investigated the effects of the Na+/K+ ATPase inhibitors, ouabain and strophanthidin, on the responses to different agonists of EAA receptors in identified medium-sized spiny neurons electrophysiologically recorded in the current- and voltage-clamp modes. In most of the cells both ouabain and strophanthidin (1-3 microM) did not cause significant change in the membrane properties of the recorded neurons. Higher doses of either ouabain (30 microM) or strophanthidin (30 microM) induced, per se, an irreversible inward current coupled to an increase in conductance, leading to cell deterioration. Moreover, both ouabain (1-10 microM) and strophanthidin (1-10 microM) dramatically increased the membrane depolarization and the inward current produced by subcritical concentrations of glutamate, AMPA and NMDA. These concentrations of Na+/K+ ATPase inhibitors also increased the membrane responses induced by repetitive cortical activation. In addition, since it had previously been proposed that dopamine mimics the effects of Na+/K+ ATPase inhibitors and that dopamine agonists differentially regulate the postsynaptic responses to EAAs, we tested the possible modulation of EAA-induced membrane depolarization and inward current by dopamine agonists. Neither dopamine nor selective dopamine agonists or antagonists affected the postsynaptic responses to EAAs. Our experiments show that impairment of the activity of Na+/K+ ATPase may render striatal neurons more sensitive to the action of glutamate, lowering the threshold for the excitotoxic events. Our data support neither the role of dopamine as an ouabain-like agent nor the differential modulatory action of dopamine receptors on the EAA-induced responses in the striatum.

Neurochemical and morphological changes associated with human epilepsy

To date a multitude of studies into the morphology and neurochemistry of human epilepsy have been undertaken with variable, and often inconsistent, results. This review summarises these studies on a range of neurotransmitters, neuromodulators, neuropeptides and their receptors. In addition to this, novel changes in cell viability and sprouting have been identified and are discussed. Whether the alterations observed are a result of the seizures or are a contributory factor is unclear. However, it may be that following an initial insult (such as febrile convulsions, status epilepticus or head injury) secondary processes occur both of an anticonvulsant nature in an attempt to compensate for seizure activity, and in a kindling type of fashion, resulting in an increased susceptibility to seizures, leading to future seizures. Many of the alterations documented in this study probably represent one or both of these processes. Clearly no single chemical abnormality or morphological alteration is going to explain the clinically diverse disorder of epilepsy. However, by drawing together the neurochemistry and morphology of epilepsy, we may begin to understand the mechanisms involved in seizure disorders.

Na,K-ATPase is decreased in hippocampus of kainate-lesioned rats

The effects of intraventricular injection of kainic acid on the Na,K-ATPase (Na,K pump) were examined in discrete pyramidal cell regions of rat hippocampus. [3H]Ouabain binding was used to quantitate Na,K-ATPase catalytic subunits and in situ hybridization was used to determine Na,K-ATPase mRNA levels. Large decreases were found in both [3H]ouabain binding and alpha 3 isoform mRNA in hippocampus areas, especially in the CA3 pyramidal cell layer, which sustains heavy cell losses as a result of bilateral, intraventricular injection of kainic acid. Substantial decreases in the high affinity component of ouabain binding and in the alpha 3 isoform mRNA (but not isoforms for other Na,K-ATPase subunits) were also observed in the CA1 region of hippocampus, an area preserved in this model. High affinity [3H]ouabain binding was decreased 25-33% in the stratum pyramidale and stratum radiatum after treatment with kainic acid, and alpha 3 mRNA was decreased by 26-50%. To further characterize the decrease in alpha 3 mRNA, animals were killed at 1, 2, and 3 weeks after injection of kainate and results show a large decrease in alpha 3 mRNA only at 2 weeks recovery time. While the pathology underlying temporal lobe epilepsy is unclear, changes in the Na,K-ATPase may be involved in abnormal firing characteristics of cells in epileptic tissue.

Severe phenytoin-induced bone marrow depression and agranulocytosis treated with human recombinant granulocyte-macrophage colony-stimulating factor. Case report

An unusual instance of severe and potentially lethal depression of the bone marrow is described as a result of the administration of phenytoin for seizure prophylaxis. The patient was treated successfully by prompt cessation of phenytoin and intravenous administration of human recombinant granulocyte-macrophage colony-stimulating factor.

Chemical systems for delivery of antiepileptic drugs to the central nervous system

The chemical delivery system (CDS) approach, a recently developed procedure conceived to enhance the specific central nervous system (CNS) uptake of drugs, has been applied to several antiepileptic agents. CDSs based on dihydropyridine<-->pyridinium salt type redox targetors, reversibly linked to the drug, were designed, synthesized and tested for some traditional (phenytoin, valproate) and potential (stiripentol) antiepileptic drugs, as well as some compounds (GABA, adenosine) with important roles in epileptogenesis. Physicochemical, in vitro stability, in vivo tissue distribution, activity and toxicity studies were performed for the new derivatives. The results of these investigations indicated that selected CDSs possessed properties required for delivering the drugs to the CNS. In vivo experiments indicated improved brain uptake and enhanced pharmacologic activity in some of the examined cases. On the other hand, no toxic side effects were registered during the studies. Properly developed CDSs could enhance the therapeutic indexes of the anticonvulsant drugs.

Neonatal status convulsivus, spongiform encephalopathy, and low activity of Na+/K(+)-ATPase in the brain

The first and second child of a family died from neonatal seizures with no detectable brain malformation, metabolic, infectious, or chromosomal etiology. Neuropathological examination of the brain of the second child who died at 11 days revealed a widespread spongy state and a selective vulnerability of the astrocytes characterized by numerous enlarged bare astrocytic nuclei and different forms of astrocyte degeneration. The glial cells were strongly positive for glial fibrillary acidic protein and vimentin immunocytochemical reaction. Cortical measurement of Na+/K(+)-ATPase revealed very low enzyme activity. We hypothesize that a defect of Na+/K(+)-ATPase of the astrocytes could be the common pathogenetic factor for the congenital status convulsivus and for the spongy state.

Phosphorylation of brain (Na+,K+)-ATPase alpha catalytic subunits in normal and epileptic cerebral cortex: II. Partial seizures in human epilepsy

We examined the activity and phosphorylation level of (Na+,K+)-ATPase (E.C. 3.6.1.3) partially purified from normal and epileptic human cortices. Control patients (n = 11) were operated on for a non-epileptogenic deep brain lesion, while epileptic patients (n = 10) were operated on for temporal or frontal originating partial seizures, resistant to medications or secondary to evolutive brain tumors. No differences in the specific activity of microsomal (Na+,K+)-ATPase were observed between the two groups of patients. After partial purification of the enzyme followed by SDS-polyacrylamide gel electrophoresis, (Na+,K+)-ATPase catalytic subunit had a decreased affinity for K+ in human epileptic cortex and lost its sensitivity to phenytoin dephosphorylation. Indirect evidence suggests that those abnormalities of (Na+,K+)-ATPase in human epileptic cortex hold preferentially true for the alpha(-) enzymatic subunit. Those results indicate that, in human epileptic cortex, (Na+,K+)-ATPase and most probably its glial subtype is altered in its K+ regulation and phenytoin sensitivity and could be responsible for ictal transformation and seizure spread.

Biochemical pathogenesis of post-traumatic epilepsy

Head trauma is often followed by epilepsy and may be related to the breakdown of red blood cells and hemoglobin within the CNS. Injection of hemoglobin or iron salts into the rat cortex is known to induce a chronic epileptic focus. We observed the formation of superoxide anion (O2) and hydroxyl radical (.OH) after ferric chloride injection into the rat cerebral cortex and suggest that these radicals, especially .OH, may be responsible for the initiation of lipid peroxidation in neuronal membranes and for the accelerated production of guanidine compounds in the brain, which may in turn lead to epileptogenicity. Then, we found that treatment with epigallocatechin (EGC) or a phosphate diester of vitamins E and C (EPC), which are potent .OH scavengers, significantly inhibited the formation of malondialdehyde and epileptic discharges in the iron-induced epileptic focus.

Valproyl CoA: an active metabolite of valproate?

Valproic acid exhibits a time course of antiepileptic effects suggesting a major role for active metabolites. It is proposed that valproyl-CoA, a valproate metabolite previously identified in liver, may accumulate in brain as a result of normal fatty acid turnover processes. Valproyl CoA could contribute to valproate's antiepileptic activity by stimulating Na+, K+-ATPase activity when brain ATP concentration is low.

Mapping the gene for juvenile myoclonic epilepsy

The practice of epileptology at a molecular level, where gene products are identified by gene mapping, will soon be possible for a growing number of epilepsies. Juvenile myoclonic epilepsy (JME) is the first of such epilepsies to be mapped to a chromosome, namely chromosome 6p21.3. Family studies of 68 JME probands from California revealed 50% of all families reported seizures in first- or second-degree relatives. Twelve percent of all family members other than the proband had epileptic seizures. Eighty percent of symptomatic siblings and 6% of asymptomatic siblings had diffuse 4- to 6-Hz multispike-wave complexes. Twelve percent of asymptomatic parents had diffuse, nonspecific slow waves mixed with spikes or sharp waves. JME is tightly linked to the Bf-HLA loci in chromosome 6. No matter what mode of inheritance is assumed, linkage to the clinical manifestations of JME and its associated EEG traits is indicated by lod scores over 3.0, as long as "EEG affected" but clinically asymptomatic family members are counted as affected during LIPED analysis. Studies are now being done to further localize the JME site. At the same time, further linkage studies should decide if JME is heterogeneous within itself and whether the same JME site in 6p21.3 underlies absence and grand mal epilepsies.

Improved anticonvulsant activity of phenytoin by a redox brain delivery system. III: Brain uptake and pharmacological effects

Phenytoin (DPH) was delivered to the brain by a dihydropyridine in equilibrium pyridinium salt redox system, which was evaluated for anticonvulsant activity. Following iv injection of the lipophilic delivery system of DPH (2) to rats, concentrations of DPH were lower but sustained and, after 30 min, essentially the same as the levels after equimolar administration of DPH. While 2 delivered the same levels of DPH to the brain as DPH did, it was twice as potent as DPH in rats (ED50 was 7.5 mumol/kg for 2 and 14.2 mumol/kg for DPH) and mice (2: 10.5; DPH: 23.9) against maximal electroshock seizures (MES), and seven times more potent in mice (2: 10.0, DPH: 70.6) against maximal pentylenetetrazole seizures (MPS). Moreover, 2 was active against pentylenetetrazole threshold seizures (PTS) in mice and rats (ED50 = 44.1 and 40.5 mumol/kg, respectively), while DPH was ineffective (up to a dose of 79.2 mumol/kg). After evaluation of acute neurological toxicity in rats, 2 was found to possess 1.5 times higher a protective index (for MES) than DPH. It appeared also that while DPH was 2.9 times less sensitive to MPS than to MES, 2 was equally potent to both types of convulsions. Thus, the data indicate that 2 delivered DPH more efficiently to the brain. The better anticonvulsant activity (quantitatively as well as qualitatively) of 2 can be explained on the basis of an improved distribution in the brain due to its higher lipophilicity, and by favorable regional differences in the rates of conversion of 2 to DPH at the convulsing foci.

Improved anticonvulsant activity of phenytoin by a redox brain delivery system I: Synthesis and some properties of the dihydropyridine derivatives

Nine chemical delivery systems (CDSs) were synthesized for the efficient transport of phenytoin (DPH) across the blood-brain barrier. The CDSs were based on a dihydropyridine in equilibrium quaternary pyridinium ion redox system which relies on chemistry similar to the NADH in equilibrium NAD interconversion for activity. The chemical carriers, derivatives of trigonelline, 1-alkylcarboxynicotinamide, 3-pyridylacetic acid, and N-methylpicolinic acid, were esterified with 3-(hydroxymethyl)phenytoin. The CDSs proved to be more lipophilic (5-23 times) than DPH. The 1-alkylcarboxydihydronicotinamide CDSs, excluding the sterically hindered one (11e), were quite unstable in rat tissue homogenates and hydrolyzed to release DPH. In human blood, however, they were found to be much more stable (75 times) toward hydrolysis. All other CDSs were oxidized quantitatively to the corresponding pyridinium ion in rat brain homogenates. These compounds were found to possess the required physicochemical characteristics for delivering DPH into rat brain.

Serotonin-dependent (Na+,K+)ATPase in kindled rats: a study in various brain regions

Serotonin (5-HT) modulation of brain (Na+,K+)ATPase, has recently been proposed. Activation curves of the enzyme activity dependent on 5-HT concentration have previously been observed in various brain regions of normal rats. In the present study, we report the absence of 'normal' (Na+,K+)ATPase response to 5-HT in cerebral cortex, striatum and diencephalon of kindled rats.

Human brain phenytoin: correlation with unbound and total serum concentrations

Simultaneous brain (gray matter) and serum specimens from 18 patients treated with oral phenytoin, who underwent cortical resections for intractable seizures, were analyzed by HPLC. The correlation between brain phenytoin concentration and unbound (free) phenytoin (r = 0.98-0.99) was significantly better than the correlation between brain phenytoin and total serum phenytoin (r = 0.90-0.93). Phenytoin concentrations in tissue from epileptic foci were slightly lower than brain phenytoin concentrations in non-epileptic regions in the same patient (means 15.0 vs. 15.5 micrograms/g, P less than 0.05). The results support the value of monitoring unbound phenytoin in clinical situations where phenytoin binding is highly variable.

Reduced ouabain binding to erythrocytes in epilepsy--evidence for a membrane abnormality

The number of sodium pump sites on erythrocytes was measured using tritiated ouabain in 20 untreated fasted patients with recent-onset untreated primary generalised or partial seizures and in 22 age- and sex-matched controls. The ouabain binding was significantly lower at 1393 +/- 392 molecules ouabain/pl cells compared to 1677 +/- 366 molecules ouabain/pl cells in the group with epilepsy (P less than 0.02). The differences between ouabain binding in patient and control groups were greater for males than for females. There were no significant differences between patients with generalised and those with partial seizures. These results are consistent with a generalised membrane abnormality in epilepsy which, if present in the brain, might predispose to seizures.

Relationship between epileptic activity and edema formation in the acute phase of cryogenic lesion

Following cryogenic lesions of the brain in the rabbit, ictal activity appears within min with a maximum at 2 h. Brain edema increases rapidly between 2-4 h with a maximum at 8 h. The glutamate concentration reaches 209% of control in the perilesional area at 2 h and the time course of glutamate/GABA ratio parallels the time course of epileptic activity. The impairment of Na+-K+-ATPase activity (rise of KMapp for K+) in the glial fraction coincides with the increase of edema. A positive correlation is found between the total amount of ictal activity and the total amount of edema in individual animals, suggesting that epilepsy may enhance edema formation.

Differences in antiepileptic drug efficacy in hippocampally kindled normal and microcephalic rats

The difference in antiepileptic drug efficacy was investigated in two groups of animals: 5 normal and 4 microcephalic rats. The latter were produced by a single i.p. injection of 30 mg/kg methylazoxymethanol acetate in the mother on the 15th day of gestation. Hippocampal kindling was performed to a seizure criterion in all animals followed by testing of the antiepileptic drugs vs placebo. Besides carbamazepine (CBZ), two new anticonvulsants were tested: (E)-2-[(alpha-amino)phenylmethylene]-benzo-[b]-thiophene-3(2H)-one (AF-CX 921) and its metabolite (E)-2-[alpha-amino)phenylmethylene]-benzo-[b]-thiophene-3(2H)-one- 1- oxide (AF-CX 1325). Frequency of occurrence and duration of afterdischarges and seizures were statistically examined. The duration of early afterdischarges (AD1) tended to be shorter in microcephalic than in normal animals in control and placebo periods. In contrast, during treatment with the antiepileptic drugs, AD1 durations were longer in microcephalic than in normal animals. This suggests that the drugs inhibited AD1 to a lesser extent in the microcephalics. Two other characteristics of EEG epileptic activity, focal spiking (FS) and late afterdischarges (AD2) also varied in the two groups. Both were significantly lower in occurrence in the microcephalic rats independent of treatment. Three types of behavioral manifestations were also examined: convulsive seizures (CS), epileptic behavior (EB) and quiet states (Q). The two groups of animals responded differently to the drugs with respect to Q and CS. In the microcephalics, AFCX 1325 and AFCX 921 were superior to CBZ, which in turn, was superior to placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Phenytoin dephosphorylates the catalytic subunit of the (Na+,K+)-ATPase in C57/BL mice

The effects of phenytoin, a potent antiepileptic drug, on the active transport of cations within membranes remain controversial. To assess the direct effects of phenytoin on the Na+,K+ pump, we studied the drug's influence on the phosphorylation of partially purified (Na+,K+)-ATPase from mouse brain. (Na+,K+)-ATPase subunits were resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Phenytoin, in vitro, decreased net phosphorylation of the (Na+,K+)-ATPase catalytic subunit in a dose-dependent manner (approximately 50% at 10(-4) M). When the conversion of E1-P to E2-P, e.g., the two major phosphorylated conformational states of (Na+,K+)-ATPase, was blocked by oligomycin or N-ethylmaleimide, phenytoin had no effect. The results suggest that phenytoin acts on the phosphatasic component of the reaction cycle, decreasing the phosphorylation level of the enzyme.

The effect of vanadate on Na+,K+-ATPase activity of mouse cerebral cortex during bicuculline-induced seizures

The effect of bicuculline-induced seizures on Na+,K+-ATPase activity of mouse cerebral cortex homogenates, using two different procedures of sample preparation (freezing in situ or decapitation of animals without freezing) is described. Regardless of tissue treatment Na+,K+-ATPase activities during bicuculline-induced seizures did not differ significantly from the appropriate controls when vanadate-free ATP was used as substrate. The response of Na+,K+-ATPase to K+ activation was also similar; the increase in potassium concentration from 2 to 20 mM caused a 33.0 and 32.3% increase of enzyme activity in cortical homogenates from control and convulsing mice, respectively. Vanadate added to the assay medium inhibited Na+,K+-ATPase activity in a dose-dependent manner; with both types of tissue treatment there was, however, a tendency towards lesser inhibition of the enzyme from convulsing mice and at 1 X 10(-7) M vanadate this difference, though slight, was statistically significant: -22.59 vs -27.55% (freezing) and -28.73 vs -38.42% (decapitation) for seizures vs controls, respectively. The reduced sensitivity of Na+,K+-ATPase towards vanadate inhibition in cortical homogenates prepared from mice with convulsions suggests that vanadate might play a role in the modulation of enzyme activity during seizures in vivo.

Alpha-1 adrenoceptors are decreased in human epileptic foci

Cortical alpha-1 adrenoceptors were measured in tissues obtained from 10 patients immediately following temporal lobectomy for intractable partial epilepsy. At operation each patient exhibited spontaneous spiking restricted to either the anterior (n = 5) or posterior (n = 5) portion of the first two temporal gyri. Control samples were obtained from the nonspiking half of the same gyrus. Receptor-binding assays were performed on isolated cortical membranes using [3H]prazosin. There was a reduction (p less than 0.01) in the receptor density (beta max) of the sites in the epileptic foci without any change in affinity (mean +/- SEM): spiking--beta max, 160.5 +/- 11.3 fmol/mg protein; affinity, 0.17 +/- 0.04 nM; nonspiking--beta max, 218.8 +/- 15.6 fmol/mg protein; affinity 0.17 +/- 0.04 nM. This relative decrease in alpha-1 adrenoceptor density may be the substratum of a noradrenergic hyposensitivity that could contribute to a localized diminution in inhibitory mechanisms in epileptic foci.

(Na+ + K+)-ATPase: function, structure, and conformations

Na+- and K+ -dependent adenosine triphosphatase [(Na+ + K+)-ATPase] plays a pivotal role in the homeostasis of Na+, K+, and Ca2+ in cells. Although the structural and enzymatic characteristics of this enzyme are being rapidly elucidated, the mechanisms underlying the vectorial movement of ions remain unclear. An understanding of the mechanism and localization of this enzyme is of importance in the study of epilepsy, since a possible defect leading to epilepsy may involve the inability of cellular elements to clear extracellular K+. Studies of conformational changes associated with the binding of specific ligands to the enzyme are being used to understand better the mechanism of the (Na+ + K+)-ATPase found in nervous tissue and transporting epithelia.

The new wave of research in the epilepsies

In addition to yielding new routes of navigation, the workshops from which the material in this supplement comes developed a conceptual blueprint for priority challenges in epilepsy research. All participants called attention to the ultimate goal, namely, understanding the mechanisms of human epilepsies. And, foremost to achieving this goal is the search for polymorphisms of restriction endonuclease patterns in monogenic forms of epilepsies in an attempt to localize the abnormal gene, or genes, to a specific chromosome. In human temporal lobe epilepsy, a priority challenge is to record paroxysmal depolarization shifts in hippocampal slices in vitro, slices excised from the known site of epileptogenicity. Parallel experiments exploring biochemical membrane abnormalities in neuronal and glial membranes isolated from the hippocampal seizure focus are especially valuable. Together with genetic studies using restriction-fragment-length polymorphisms, these experiments should distinguish between the respective contributions of genetic and environmental factors in multifactorial forms of partial epilepsies, such as temporal lobe epilepsy. In the genesis and spread of human temporal lobe epilepsy, the role of kindling and the mirror focus must be resolved. Recent successful applications of positron emission tomography, single-photon-emission computed tomography, and nuclear magnetic resonance computed tomography show promise in finally constructing the ion transport pathways, neurotransmitter systems, and metabolic processes within the functioning brains of epileptic patients.

The search for epilepsies ideal for clinical and molecular genetic studies

The first step in localizing the chromosomal site of specific epilepsies is to define their pattern of inheritance. This determination is now being carried out for benign juvenile myoclonic epilepsy; fifty multigenerational families are being studied in three separate epilepsy programs in Los Angeles, Winston-Salem, NC, and Berlin. Concurrent with these studies, investigators are combining the principles of classic linkage analysis, using 30 protein markers, with the use of restriction-fragment-length polymorphisms to determine the chromosomal location of juvenile myoclonic epilepsy. Two problems appear formidable, however. First, since the chromosomal location of specific epilepsies is unknown, the entire human genome must be screened. Second, once the location of a specific epilepsy gene is narrowed down to a region of 10(6) base pairs, the problem of identifying the actual molecular defect is difficult, especially if we have no assay or method to show that a given gene is culpable for producing epilepsy. An approach more likely to succeed is to use as markers the DNA fragments of proteins that are suspected to cause the disease in experimental models of genetic epilepsies; for example, the gamma-aminobutyric acid receptor genes, which are suspected to cause myoclonic epilepsy in experimental animals, can be tested in benign juvenile myoclonic epilepsy. At the same time, other marker proteins could be used to locate the chromosomal site of other specific epilepsies. Once the chromosomal site is determined, recombinant DNA technology will permit the measurement of the precise arrangement of the genes for these restriction-fragment-length polymorphisms and protein markers at a given locus of a chromosome.

Glial and neuronal Na+-K+ pump in epilepsy

Because high extracellular K+ concentrations (18-20 mM) increased glial Na+- and K+ -dependent adenosine triphosphatase [(Na+ + K+)-ATPase] activities, while this increase was not observed in neuronal preparations, it is hypothesized that K+ released in the extracellular space during neuronal firing is actively taken up by glial cells. In acute and chronic epileptogenic lesions of cats, glial (Na+ + K+)-ATPase dramatically decreased when compared to both control animals and the perifocal area, while its activation by extracellular K+ in concentrations between 3 and 18 mM was absent 3, 6, and up to 45 days after production of freezing lesions. Similar results were observed in 13 specimens of anterolateral temporal neocortex obtained during temporal lobectomies in patients with intractable temporal lobe epilepsy, compared with postmortem human specimen or control brain tissues. Hence, a glial (Na+ + K+)-ATPase abnormality exists in epileptogenic tissue. Further experimental data are presented supporting the notion that this glial abnormality may favor the transition from interictal episodes to ictal phenomena.