Let's Talk About Sex: Integrating Sex as a Biological Variable Into Epilepsy Research

Perception and Attitude of the General Population towards Epilepsy in Jeddah, Saudi Arabia

Background and Purpose

There are several conflicting beliefs about epilepsy, and public awareness about this disease varies widely among different countries. The present study aimed to determine public perception and attitude regarding different aspects of epilepsy in Jeddah, Saudi Arabia. In addition, we aim to identify the cultural and religious beliefs in Saudi Arabia associated with the causes and treatment of epilepsy.

Methods

This is a cross-sectional study that was conducted between January 2018 and June 2018 in malls and public places in Jeddah, Saudi Arabia. This study utilized a self-administered questionnaire composed of 40 items.

Results

A total of 1,940 individuals participated in the study, of which 1,675 participants (86.3%) had previously heard about epilepsy. Approximately 60% of the participants believed that epilepsy was caused by a brain disease and 17.1% believed that it is a genetic disease. Over 50% of the participants believed that epilepsy is treated with medications, 31.5% believed that it can be treated by the recitation of Quran, and 16.2% believed that it can be treated by surgery, while 10.2% believe that there is no treatment.

Conclusions

The results of the present study suggest that awareness about epilepsy in the general public should be raised to avoid a negative impact on the patients, their families, their communities, and the healthcare system. Several misconceptions were identified, particularly in the etiology and management of the disease. Increased awareness will help in the early diagnosis, appropriate care, and management of the patients, and lead to better social acceptance. Dissemination of information about epilepsy through social media should be considered to reach a great proportion of the general public.

Comparison of kainate-induced seizures, cognitive impairment and hippocampal damage in male and female mice

Kainate (KA) mouse model induced by intraperitoneal injection has been widely used for epilepsy and neurodegeneration studies. KA elicits sustained epileptic activity in mouse brain revealed by recurrent behavioral seizures, deteriorative neurodegeneration and various neurological deficits. However, to date, the vast majority of the studies used male mice only, and few studies on the comparison of brain injury between male and female mice in this model were reported. Epidemiological studies indicate that sex may affect the susceptibility to seizure response and neurodegeneration process. Therefore, this study focused on the effect of sex difference on KA-induced recurrent seizures and mortality, locomotor activity and cognitive impairment, and hippocampal neurodegeneration and reactive gliosis in mice. Our results showed that, compared to females, adult male mice exhibited worse performance in mortality rate, severity of epileptic seizures, and cognitive impairment indicated by novel object recognition task. Unexpectedly, post-KA male and female mice underwent similar decline and recovery of locomotor activity. KA-induced neurodegeneration in the whole hippocampus, particularly in CA1 and CA3 subregions, along with the deteriorative reactive gliosis in astrocytes and microglia, was more severe in males than that in females. These data provided the direct in vivo evidence that indicates the key role of sex difference in studies with KA mouse model, and this could be beneficial for optimizing the design of future studies.

Sex-Dependent Signaling Pathways Underlying Seizure Susceptibility and the Role of Chloride Cotransporters

Seizure incidence, severity, and antiseizure medication (ASM) efficacy varies between males and females. Differences in sex-dependent signaling pathways that determine network excitability may be responsible. The identification and validation of sex-dependent molecular mechanisms that influence seizure susceptibility is an emerging focus of neuroscience research. The electroneutral cation-chloride cotransporters (CCCs) of the SLC12A gene family utilize Na⁺-K⁺-ATPase generated electrochemical gradients to transport chloride into or out of neurons. CCCs regulate neuronal chloride gradients, cell volume, and have a strong influence over the electrical response to the inhibitory neurotransmitter GABA. Acquired or genetic causes of CCCs dysfunction have been linked to seizures during early postnatal development, epileptogenesis, and refractoriness to ASMs. A growing number of studies suggest that the developmental expression of CCCs, such as KCC2, is sex-dependent. This review will summarize the reports of sexual dimorphism in epileptology while focusing on the role of chloride cotransporters and their associated modulators that can influence seizure susceptibility.