Developmental changes of ketamine action against epileptic afterdischarges induced by hippocampal stimulation in rats

Blockade of GluN2B-containing NMDA receptors reduces short-term brain damage induced by early-life status epilepticus

Status epilepticus (SE) during developmental periods can cause short- and long-term consequences to the brain. Brain damage induced by SE is associated to NMDA receptors (NMDAR)-mediated excitotoxicity. This study aimed to investigate whether blockade of GluN2B-containing NMDAR is neuroprotective against SE-induced neurodegeneration and neuroinflammation in young rats. Forty-eight Wistar rats (16 days of life) were injected with pilocarpine (60 mg/kg; i.p.) 12-18 h after LiCl (3 mEq/kg; i.p.). Fifteen minutes after pilocarpine administration, animals received i.p. injections of saline solution (0.9% NaCl; SE + SAL group), ketamine (a non-selective and noncompetitive NMDAR antagonist; 25 mg/kg; SE + KET), CI-1041 (a GluN2B-containing NMDAR antagonist; 10 mg/kg; SE + CI group) or CP-101,606 (a NMDAR antagonist with great selectivity for NMDAR composed by GluN1/GluN2B diheteromers; 10 mg/kg; SE + CP group). Seven days after SE, brains were removed for Fluoro-Jade C staining and Iba1/ED1 immunolabeling. GluN2B-containing NMDAR blockade by CI-1041 or CP-101,606 did not terminate LiCl-pilocarpine-induced seizures. SE + SAL group presented intense neurodegeneration and Iba1⁺/ED1⁺ double-labeling in hippocampus (CA1 and dentate gyrus; DG) and amygdala (MePV nucleus). Administration of CP-101,606 did not alter this pattern. However, GluN2B-containing NMDAR blockade by CI-1041 reduced neurodegeneration and Iba1⁺/ED1⁺ double-labeling in hippocampus and amygdala similar to the reduction observed for SE + KET group. Our results indicate that GluN2B-containing NMDAR are involved in SE-induced neurodegeneration and microglial recruitment and activation, and suggest that stopping epileptic activity is not a condition required to prevent short-term brain damage in young animals.

NMDA and AMPA receptors: development and status epilepticus

Glutamate is the main excitatory neurotransmitter in the brain and ionotropic glutamate receptors mediate the majority of excitatory neurotransmission (Dingeldine et al. 1999). The high level of glutamatergic excitation allows the neonatal brain (the 2(nd) postnatal week in rat) to develop quickly but it also makes it highly prone to age-specific seizures that can cause lifelong neurological and cognitive disability (Haut et al. 2004). There are three types of ionotropic glutamate receptors (ligand-gated ion channels) named according to their prototypic agonists: N-methyl-D-aspartate (NMDA), 2-amino-3-(3-hydroxy-5-methyl-isoxazol-4-yl) propanoic acid (AMPA) and kainate (KA). During early stages of postnatal development glutamate receptors of NMDA and AMPA type undergo intensive functional changes owing to modifications in their subunit composition (Carter et al. 1988, Watanabe et al. 1992, Monyer et al. 1994, Wenzel et al. 1997, Sun et al. 1998, Lilliu et al. 2001, Kumar et al. 2002, Matsuda et al. 2002, Wee et al. 2008, Henson et al. 2010, Pachernegg et al. 2012, Paoletti et al. 2013). Participation and role of these receptors in mechanisms of seizures and epilepsy became one of the main targets of intensive investigation (De Sarro et al. 2005, Di Maio et al. 2012, Rektor 2013). LiCl/Pilocarpine (LiCl/Pilo) induced status epilepticus is a model of severe seizures resulting in development temporal lobe epilepsy (TLE). This review will consider developmental changes and contribution of NMDA and AMPA receptors in LiCl/Pilo model of status epilepticus in immature rats.

Treatment of status epilepticus with ketamine, are we there yet?

Status epilepticus (SE), a neurological emergency both in adults and in children, could lead to brain damage and even death if untreated. Generalized convulsive SE (GCSE) is the most common and severe form, an example of which is that induced by organophosphorus nerve agents. First- and second-line pharmacotherapies are relatively consensual, but if seizures are still not controlled, there is currently no definitive data to guide the optimal choice of therapy. The medical community seems largely reluctant to use ketamine, a noncompetitive antagonist of the N-methyl-d-aspartate glutamate receptor. However, a review of the literature clearly shows that ketamine possesses, in preclinical studies, antiepileptic properties and provides neuroprotection. Clinical evidences are scarcer and more difficult to analyze, owing to a use in situations of polytherapy. In absence of existing or planned randomized clinical trials, the medical community should make up its mind from well-conducted preclinical studies performed on appropriate models. Although potentially active, ketamine has no real place for the treatment of isolated seizures, better accepted drugs being used. Its best usage should be during GCSE, but not waiting for SE to become totally refractory. Concerns about possible developmental neurotoxicity might limit its pediatric use for refractory SE.

Ketamine reduces neuronal degeneration and anxiety levels when administered during early life-induced status epilepticus in rats

Status epilepticus (SE) when occurred during brain development can cause short- and long-term consequences, which are frequently associated with NMDA-mediated glutamatergic excitotoxicity. In the present work, we investigated the putative neuroprotective role of ketamine, an NMDA receptor antagonist, on early life SE-induced acute neuronal death and long-term behavioral abnormalities. Male Wistar rats (16 postnatal days) were induced to SE by LiCl-pilocarpine i.p. administration (3 mEq/kg; 60 mg/kg, respectively). Fifteen or 60min after pilocarpine injection, animals received a ketamine administration (22.5mg/kg i.p.). Neuronal degeneration was assessed 24h after SE induction. Another subset of animals was destined to behavioral tasks in adulthood (75-80 postnatal days). Fluoro-Jade C labeling revealed a marked neuronal death on CA1 hippocampal subfield, habenula, thalamus and amygdala in SE animals. Ketamine post-SE onset treatment prevented neuronal death in all regions assessed. In the elevated plus maze, SE induced an increase in anxiety-like behaviors whereas ketamine administration during seizures was able to prevent this alteration. Ketamine administration in non-SE animals resulted in high anxiety levels. There were no observed differences among groups in the open field task in all parameters analyzed. Our results suggest that ketamine post-SE onset treatment was effective in preventing acute and long-standing alterations caused by SE early in life, which indicates a putative role of glutamatergic system on SE-induced brain damage as well as long-lasting behavioral consequences.

The NMDA receptor complex as a therapeutic target in epilepsy: a review

A substantial amount of research has shown that N-methyl-D-aspartate receptors (NMDARs) may play a key role in the pathophysiology of several neurological diseases, including epilepsy. Animal models of epilepsy and clinical studies demonstrate that NMDAR activity and expression can be altered in association with epilepsy and particularly in some specific seizure types. NMDAR antagonists have been shown to have antiepileptic effects in both clinical and preclinical studies. There is some evidence that conventional antiepileptic drugs may also affect NMDAR function. In this review, we describe the evidence for the involvement of NMDARs in the pathophysiology of epilepsy and provide an overview of NMDAR antagonists that have been investigated in clinical trials and animal models of epilepsy.

Effects of brief seizures during development

The effects of brief seizures during development depend on multiple factors such as underlying brain pathology, specific age of occurrence and frequency. Studies in rats are frequently used to determine the consequences of seizures in the developing brain. The shorter prepubertal development and life span of the rat compared to humans may suggest that brief seizures in the rat are not necessarily equivalent to brief seizures in humans. Nevertheless, there is substantial evidence that in the rat, the consequences of seizures are age-dependent. The immature brain is relatively resistant to morphological damage, especially in the hippocampus, and functional changes as measured by electrophysiology and behavior. Developmental kindling can be used as a model to study brief seizures early in life. Kindling permanently alters the brain so that rats stimulated again in adulthood require only few kindling stimuli for fully kindled seizures to occur although there are no apparent morphological and functional changes in the hippocampus resulting from kindling early in life. The appreciation that kindling can alter brain function without any discrete (to date) morphological changes may lead to the development of effective neuroprotective strategies to alter the process, but it is not clear that all kindling-induced changes are detrimental to the brain.

Age-specific N-methyl-D-aspartate-induced seizures: perspectives for the West syndrome model

PURPOSE

With intraperitoneal N-methyl-D-aspartate (NMDA; 15-200 mg/kg) administration, we attempted to develop an animal model of age-specific West syndrome to serve for testing of putative anticonvulsant drugs and to determine the mechanisms of this disorder.

METHODS

Experiments were performed in 12-, 18-, and 60-day-old (adult) rats. The effects of systemic pretreatment with hydrocortisone (5-25 mg/kg), pyridoxine (20-250 mg/kg), and sodium valproate (VPA; 200 and 400 mg/kg) against the NMDA-induced automatisms, emprosthotonic (hyperflexion), and clonic-tonic seizures were determined. NMDA-induced EEG changes and alterations of the performance in horizontal bar, rotorod, open field, and elevated plus-maze tests were recorded.

RESULTS

In young rats, hydrocortisone had proconvulsant effects. High doses of pyridoxine induced epileptiform activity independent of and distinct from that induced by NMDA. Only VPA had moderate effects against the NMDA-induced syndrome. EEG consisted of periods of suppression mixed with ictal activity of serrated waves and high-voltage chaotic EEG activity. In adult rats, EEG alterations involved spike and spike-and-wave activity. NMDA also deteriorated performance of young rats in the open field, rotorod, and elevated plus maze tests.

CONCLUSIONS

NMDA syndrome in rats fulfills some, but not all, criteria of the West syndrome model, such as occurrence of flexion seizures, nonspecific diffuse EEG changes, refractoriness to antiepileptic therapy (but a response to VPA), as well as long-term alteration of behavioral tasks. However, NMDA-induced seizures represent an acute model without the occurrence of spontaneous seizures, whereas in the clinical situation, both the seizures and neurologic deterioration are chronic. Further, in the West syndrome and the NMDA seizure model, there is an incongruent response to therapy with antiepileptic drugs.

Anticonvulsant action of a NMDA receptor antagonist CGP 40116 varies only quantitatively during ontogeny in rats

Anticonvulsant action of CGP 40116, a competitive antagonist of N-methyl-D-aspartate type of excitatory amino acid receptors, was studied in rats during development (7, 12, 18, 25 and 90 days old). Two types of motor seizures were elicited by a subcutaneous injection of pentylenetetrazol. Pretreatment with CGP 40116 did not influence minimal, predominantly clonic seizures in any age group. Generalized tonic-clonic seizures were at first modified--their tonic phase was restricted to forelimbs, then selectively suppressed--and with increasing dosage the clonic phase was blocked too. This effect exhibited only minor quantitative changes during development.

Proconvulsant effects induced by pyridoxine in young rats

High doses of pyridoxine (vitamin B6) can be neurotoxic in adults. Effects of intraperitoneally administered B6 (100, 250 and 400 mg/kg) were studied in 7, 12, 18 and 60 day old rats. B6 elicited epileptiform EEG discharges without any motor correlate in all age groups. In contrast, motor seizures were rare, seen only in 18 day old rats (250 mg/kg of B6). Data indicate that in young rats, B6 may have proconvulsant effects in doses relevant to those sometimes used in pediatric neurology.

Acute effects of MK801 on kainic acid-induced seizures in neonatal rats

Kainic acid (KA) causes behavioral and electrographic status epilepticus (SE) in rats of all ages. In adult rats, the noncompetitive N-methyl-D-aspartate (NMDA) channel blocker MK801 ((+)-5-methyl-10,11-dihydro-5H-dibenzo[a,d]-cyclohepten-5,10-imine ) is anticonvulsant against KA-induced seizures: it reduces their severity and protects against neuronal damage, although it may worsen electrographic seizures. Here we examined the effects of MK801 on KA seizures in the immature brain. Neonatal rats (P11-P12) were pretreated with MK801 (0.01, 0.1, 0.5 or 1.0 mg/kg, i.p.) or saline twenty minutes prior to KA (2 mg/kg, i.p.). Clinical seizure behavior was monitored for > 6 hrs, and in some rats the EEG was monitored with an intrahippocampal or intracortical electrode. MK801 caused immobility alternating with hyperactivity, ataxia, scratching and sometimes alternate limb cycling, which correlated with the appearance of spikes on the EEG. Compared to KA alone or KA preceded by 0.01 mg/kg MK801, the higher doses of MK801 (0.1, 0.5 and 1.0 mg/kg) significantly lowered the latency to electrographic seizures (P < 0.001), ictal scratching (P < 0.0001), and status epilepticus (P < 0.0001). MK801 pretreatment did not lower significantly the death rate due to KA seizures. No histologic damage was seen after MK801, KA or both agents together. These results suggest that MK801 exacerbates KA-induced seizures in the neonatal brain, and may even cause ictal behavioral and electrographic manifestations by itself. The findings point to an age-dependency of NMDA antagonist action, and suggest caution in considering the use of NMDA antagonists in neonates.

Suppression of cortical epileptic afterdischarges by ketamine is not stable during ontogenesis in rats

Anticonvulsant action of ketamine, a noncompetitive NMDA antagonist, was studied in three groups of immature rats (12-, 18-, and 25-day-old) using cortically elicited epileptic afterdischarges (ADs) as a model. Rats with implanted electrodes were used, so that EEG and motor phenomena could be recorded. Stimulation (bipolar pulses of 1-ms duration and 8-Hz frequency) lasting 15 s was repeated four times with intervals of 10 min. Ketamine was administered IP 5 min after the first AD in doses of 5, 10, 20, or 40 mg/kg. Control groups did not receive any drug. Ketamine shortened ADs and suppressed motor correlates of stimulation as well as of ADs in a dose-dependent manner in 12- and 25-day-old rats. No significant changes were observed in 18-day-old animals, demonstrating thus a rather complicated development of anticonvulsant action of ketamine. Not only NMDA antagonism, but also other possible effects of ketamine must be taken into account.

Age-dependent anticonvulsant action of clonazepam in the N-methyl-D-aspartate model of seizures

Seizures may result from an impaired balance between excitation and inhibition. We tested whether clonazepam [a benzodiazepine that enhances GABAA inhibitory transmission (0.2 or 1.0 mg/kg, intraperitoneally [i.p.])] suppresses an age-dependent pattern of N-methyl-D-aspartate (NMDA)-induced phenomena in 7-, 12-, 18-, 25-, and 60-day-old rats (10, 40, 100, 100, and 200 mg/kg of NMDA, i.p., respectively). There were no effects of clonazepam against the NMDA-induced automatisms and emprosthotonus. In 7-day-old rats, clonazepam was proconvulsant in clonic-tonic seizures (it decreased the latency to onset of seizures, whereas it was anticonvulsant in 25-day-old rats. There was no difference between anticonvulsant effects of clonazepam and its solvent in 12- and 60-day-old rats. Both cortical and hippocampal EEG seizures was extremely poor in this model. There was no improvement of EEG recording after clonazepam. The results demonstrate that impaired excitation cannot be simply balanced by an enhanced inhibition and that the drug effects in young animals cannot be predicted from the effects in adults.