Abstract
Status epilepticus (SE) is not simply a prolonged seizure. Both the clinical course and the basic mechanisms are different from a single seizure. SE often fails to respond to sequential administration of antiepileptic drugs (AEDs), originally developed for treatment of chronic seizures. Pharmacoresistance to benzodiazepines and other AEDs, which is observed soon after onset of SE, leads to loss of the effectiveness of these medications and to poor clinical outcomes. Animal models have uncovered SE-induced changes in cellular and network pathophysiology, most of them maladaptive, leading to increased excitability. Whole-cell recordings from hippocampal slices obtained from animals in SE showed alteration in both inhibitory and excitatory postsynaptic physiology. These synaptic changes result at least in part from a decrease in functional synaptic GABAA receptors (through internalization/desensitization) accompanied by a simultaneous increase in the number of membrane NMDA receptors. These findings highlight the role played by receptor trafficking in transition to and maintenance of SE. They explain, at least in part, the development of pharmacoresistance to benzodiazepines and other GABAergic drugs. These SE-associated changes suggest that the current gold standard (benzodiazepine monotherapy) treats only half the problem and that consideration should be given to using a combination of GABAA agonists and NMDA antagonists in the initial treatment.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Chen JW, Wasterlain CG. Status epilepticus: pathophysiology and management in adults. Lancet Neurol. 2006;5(3):246–56.
Shorvon S. Super-refractory status epilepticus: an approach to therapy in this difficult clinical situation. Epilepsia. 2011;52(Suppl 8):53–6.
Alvarez V, Drislane FW. Is favorable outcome possible after prolonged refractory status epilepticus? J Clin Neurophysiol. 2016;33(1):32–41.
Trinka E, Cock H, Hesdorffer D, et al. A definition and classification of status epilepticus--report of the ILAE task force on classification of status epilepticus. Epilepsia. 2015;56(10):1515–23.
DeLorenzo RJ, Hauser WA, Towne AR, et al. A prospective, population-based epidemiologic study of status epilepticus in Richmond, Virginia. Neurology. 1996;46(4):1029–35.
Rosenow F, Hamer HM, Knake S. The epidemiology of convulsive and nonconvulsive status epilepticus. Epilepsia. 2007;48(Suppl 8):82–4.
Wu YW, Shek DW, Garcia PA, et al. Incidence and mortality of generalized convulsive status epilepticus in California. Neurology. 2002;58(7):1070–6.
DeLorenzo RJ. Epidemiology and clinical presentation of status epilepticus. Adv Neurol. 2006;97:199–215.
Turski WA, Cavalheiro EA, Schwarz M, et al. Limbic seizures produced by pilocarpine in rats: behavioural, electroencephalographic and neuropathological study. Behav Brain Res. 1983;9(3):315–35.
Ben-Ari Y, Tremblay E, Ottersen OP, et al. Evidence suggesting secondary epileptogenic lesion after kainic acid: pre treatment with diazepam reduces distant but not local brain damage. Brain Res. 1979;165(2):362–5.
Honchar MP, Olney JW, Sherman WR. Systemic cholinergic agents induce seizures and brain damage in lithium-treated rats. Science. 1983;220(4594):323–5.
Punia V, Garcia CG, Hantus S. Incidence of recurrent seizures following hospital discharge in patients with LPDs (PLEDs) and nonconvulsive seizures recorded on continuous EEG in the critical care setting. Epilepsy Behav. 2015;49:250–4.
Pitkänen A, Schwartzkroin PA, Moshé SL. Models of seizures and epilepsy. Amsterdam; Boston: Elsevier Academic Press; 2006.
Wasterlain CG. Breakdown of brain polysomes in status epilepticus. Brain Res. 1972;39(1):278–84.
Wasterlain CG. Mortality and morbidity from serial seizures. An experimental study. Epilepsia. 1974;15(2):155–76.
Taber KH, McNamera JJ, Zornetzer SF. Status epilepticus: a new rodent model. Electroencephalogr Clin Neurophysiol. 1977;43(5):707–24.
de Campos CJ, Cavalheiro EA. Modification of the "kindling" method for obtaining experimental status epilepticus in rats. Arq Neuropsiquiatr. 1980;38(1):81–8.
McIntyre DC, Nathanson D, Edson N. A new model of partial status epilepticus based on kindling. Brain Res. 1982;250(1):53–63.
McIntyre DC, Stokes KA, Edson N. Status epilepticus following stimulation of a kindled hippocampal focus in intact and commissurotomized rats. Exp Neurol. 1986;94(3):554–70.
Milgram NW, Green I, Liberman M, et al. Establishment of status epilepticus by limbic system stimulation in previously unstimulated rats. Exp Neurol. 1985;88(2):253–64.
Cain DP, McKitrick DJ, Boon F. Rapid and reliable induction of partial status epilepticus in naive rats by low-frequency (3-Hz) stimulation of the amygdala. Epilepsy Res. 1992;12(1):51–5.
Inoue K, Morimoto K, Sato K, et al. Mechanisms in the development of limbic status epilepticus and hippocampal neuron loss: an experimental study in a model of status epilepticus induced by kindling-like electrical stimulation of the deep prepyriform cortex in rats. Acta Med Okayama. 1992;46(2):129–39.
Inoue K, Morimoto K, Sato K, et al. A model of status epilepticus induced by intermittent electrical stimulation of the deep prepyriform cortex in rats. Jpn J Psychiatry Neurol. 1992;46(2):361–7.
Handforth A, Ackermann RF. Hierarchy of seizure states in the electrogenic limbic status epilepticus model: behavioral and electrographic observations of initial states and temporal progression. Epilepsia. 1992;33(4):589–600.
Handforth A, Ackermann RF. Mapping of limbic seizure progressions utilizing the electrogenic status epilepticus model and the 14C-2-deoxyglucose method. Brain Res Brain Res Rev. 1995;20(1):1–23.
Lothman EW, Bertram EH, Bekenstein JW, et al. Self-sustaining limbic status epilepticus induced by 'continuous' hippocampal stimulation: electrographic and behavioral characteristics. Epilepsy Res. 1989;3(2):107–19.
VanLandingham KE, Lothman EW. Self-sustaining limbic status epilepticus. I. Acute and chronic cerebral metabolic studies: limbic hypermetabolism and neocortical hypometabolism. Neurology. 1991;41(12):1942–9.
Lothman EW, Bertram EH, Kapur J, et al. Recurrent spontaneous hippocampal seizures in the rat as a chronic sequela to limbic status epilepticus. Epilepsy Res. 1990;6(2):110–8.
Vicedomini JP, Nadler JV. A model of status epilepticus based on electrical stimulation of hippocampal afferent pathways. Exp Neurol. 1987;96(3):681–91.
Sloviter RS. Decreased hippocampal inhibition and a selective loss of interneurons in experimental epilepsy. Science. 1987;235(4784):73–6.
Mazarati AM, Wasterlain CG, Sankar R, et al. Self-sustaining status epilepticus after brief electrical stimulation of the perforant path. Brain Res. 1998;801(1–2):251–3.
Nissinen J, Halonen T, Koivisto E, et al. A new model of chronic temporal lobe epilepsy induced by electrical stimulation of the amygdala in rat. Epilepsy Res. 2000;38(2–3):177–205.
van Vliet EA, Aronica E, Tolner EA, et al. Progression of temporal lobe epilepsy in the rat is associated with immunocytochemical changes in inhibitory interneurons in specific regions of the hippocampal formation. Exp Neurol. 2004;187(2):367–79.
Wang NC, Good LB, Marsh ST, et al. EEG stages predict treatment response in experimental status epilepticus. Epilepsia. 2009;50(4):949–52.
Treiman DM, Walton NY, Kendrick C. A progressive sequence of electroencephalographic changes during generalized convulsive status epilepticus. Epilepsy Res. 1990;5(1):49–60.
Sales ME. Muscarinic receptors as targets for anti-inflammatory therapy. Curr Opin Investig Drugs. 2010;11(11):1239–45.
Curia G, Longo D, Biagini G, et al. The pilocarpine model of temporal lobe epilepsy. J Neurosci Methods. 2008;172(2):143–57.
Buterbaugh GG, Michelson HB, Keyser DO. Status epilepticus facilitated by pilocarpine in amygdala-kindled rats. Exp Neurol. 1986;94(1):91–102.
Morrisett RA, Jope RS, Snead OC, 3rd. Effects of drugs on the initiation and maintenance of status epilepticus induced by administration of pilocarpine to lithium-pretreated rats. Exp Neurol 1987;97(1):193–200.
Suchomelova L, Baldwin RA, Kubova H, et al. Treatment of experimental status epilepticus in immature rats: dissociation between anticonvulsant and antiepileptogenic effects. Pediatr Res. 2006;59(2):237–43.
Naylor DE, Wasterlain CG. GABA synapses and the rapid loss of inhibition to dentate gyrus granule cells after brief perforant-path stimulation. Epilepsia. 2005;46(Suppl 5):142–7.
Naylor DE, Liu H, Wasterlain CG. Trafficking of GABA(A) receptors, loss of inhibition, and a mechanism for pharmacoresistance in status epilepticus. J Neurosci. 2005;25(34):7724–33.
Kapur J, Macdonald RL. Rapid seizure-induced reduction of benzodiazepine and Zn2+ sensitivity of hippocampal dentate granule cell GABAA receptors. J Neurosci. 1997;17(19):7532–40.
Mazarati AM, Baldwin RA, Sankar R, et al. Time-dependent decrease in the effectiveness of antiepileptic drugs during the course of self-sustaining status epilepticus. Brain Res. 1998;814(1–2):179–85.
22nd IEC Proceedings. Epilepsia 1997;38:1–284.
Naylor DE, Liu H, Niquet J, et al. Rapid surface accumulation of NMDA receptors increases glutamatergic excitation during status epilepticus. Neurobiol Dis. 2013;54:225–38.
Johnson EA, Kan RK. The acute phase response and soman-induced status epilepticus: temporal, regional and cellular changes in rat brain cytokine concentrations. J Neuroinflammation. 2010;7:40.
Miller SL, Aroniadou-Anderjaska V, Figueiredo TH, et al. A rat model of nerve agent exposure applicable to the pediatric population: The anticonvulsant efficacies of atropine and GluK1 antagonists. Toxicol Appl Pharmacol. 2015;284(2):204–16.
McDonough Jr JH, Shih TM. Pharmacological modulation of soman-induced seizures. Neurosci Biobehav Rev. 1993;17(2):203–15.
Smythies J, Golomb B. Nerve gas antidotes. J R Soc Med. 2004;97(1):32.
Nakajima T, Ohta S, Morita H, et al. Epidemiological study of sarin poisoning in Matsumoto City, Japan. J Epidemiol. 1998;8(1):33–41.
Walton NY, Treiman DM. Experimental secondarily generalized convulsive status epilepticus induced by D,L-homocysteine thiolactone. Epilepsy Res. 1988;2(2):79–86.
Wasterlain CG. Developmental brain damage after chemically induced epileptic seizures. Eur Neurol. 1975;13(6):495–8.
Soderfeldt B, Kalimo H, Olsson Y, et al. Bicuculline-induced epileptic brain injury. Transient and persistent cell changes in rat cerebral cortex in the early recovery period. Acta Neuropathol. 1983;62(1–2):87–95.
el Hamdi G, de Vasconcelos AP, Vert P, et al. An experimental model of generalized seizures for the measurement of local cerebral glucose utilization in the immature rat. I. Behavioral characterization and determination of lumped constant. Brain Res Dev Brain Res. 1992;69(2):233–42.
Bernard C. Chapter 6—Hippocampal slices: designing and interpreting studies in epilepsy research A2. In: Pitkänen A, Schwartzkroin PA, Moshé SL, editors. Models of Seizures and Epilepsy. Burlington: Academic Press; 2006. p. 59–72.
Reddy DS, Kuruba R. Experimental models of status epilepticus and neuronal injury for evaluation of therapeutic interventions. Int J Mol Sci. 2013;14(9):18284–318.
Avoli M, Barbarosie M, Lucke A, et al. Synchronous GABA-mediated potentials and epileptiform discharges in the rat limbic system in vitro. J Neurosci. 1996;16(12):3912–24.
Salami P, Levesque M, Avoli M. High frequency oscillations can pinpoint seizures progressing to status epilepticus. Exp Neurol. 2016;280:24–9.
Heinemann U, Buchheim K, Gabriel S, et al. Coupling of electrical and metabolic activity during epileptiform discharges. Epilepsia. 2002;43(Suppl 5):168–73.
Traynelis SF, Dingledine R. Potassium-induced spontaneous electrographic seizures in the rat hippocampal slice. J Neurophysiol. 1988;59(1):259–76.
Feng Z, Durand DM. Effects of potassium concentration on firing patterns of low-calcium epileptiform activity in anesthetized rat hippocampus: inducing of persistent spike activity. Epilepsia. 2006;47(4):727–36.
Xiong ZQ, Stringer JL. Prolonged bursts occur in normal calcium in hippocampal slices after raising excitability and blocking synaptic transmission. J Neurophysiol. 2001;86(5):2625–8.
Stoppini L, Buchs PA, Muller D. A simple method for organotypic cultures of nervous tissue. J Neurosci Methods. 1991;37(2):173–82.
Heinemann UWE, Kann O, Schuchmann S. Chapter 4—An overview of in vitro seizure models in acute and organotypic slices A2. In: Pitkänen A, Schwartzkroin PA, Moshé SL, editors. Models of Seizures and Epilepsy. Burlington: Academic Press; 2006. p. 35–44.
Kovacs R, Schuchmann S, Gabriel S, et al. Free radical-mediated cell damage after experimental status epilepticus in hippocampal slice cultures. J Neurophysiol. 2002;88(6):2909–18.
Zepeda A, Arias C, Sengpiel F. Optical imaging of intrinsic signals: recent developments in the methodology and its applications. J Neurosci Methods. 2004;136(1):1–21.
Phillips KF, Deshpande LS, DeLorenzo RJ. Hypothermia reduces calcium entry via the N-methyl-D-aspartate and ryanodine receptors in cultured hippocampal neurons. Eur J Pharmacol. 2013;698(1–3):186–92.
Wasterlain C, Treiman D, et al. Status epilepticus: Mechanisms of brain damage and treatment. New York: Raven Press; 1983. p. 15–35.
Fernandez-Torre JL, Kaplan PW, Hernandez-Hernandez MA. New understanding of nonconvulsive status epilepticus in adults: treatments and challenges. Expert Rev Neurother. 2015;15(12):1455–73.
Mazarati AM, Wasterlain CG. N-methyl-D-asparate receptor antagonists abolish the maintenance phase of self-sustaining status epilepticus in rat. Neurosci Lett. 1999;265(3):187–90.
Wasterlain CG, Baldwin R, Naylor DE, et al. Rational polytherapy in the treatment of acute seizures and status epilepticus. Epilepsia. 2011;52(Suppl 8):70–1.
Staley KJ, Soldo BL, Proctor WR. Ionic mechanisms of neuronal excitation by inhibitory GABAA receptors. Science. 1995;269(5226):977–81.
Goodkin HP, Yeh JL, Kapur J. Status epilepticus increases the intracellular accumulation of GABAA receptors. J Neurosci. 2005;25(23):5511–20.
Bertram EH, Lothman EW. NMDA receptor antagonists and limbic status epilepticus: a comparison with standard anticonvulsants. Epilepsy Res. 1990;5(3):177–84.
Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48–61.
Silbergleit R, Durkalski V, Lowenstein D, et al. Intramuscular versus intravenous therapy for prehospital status epilepticus. N Engl J Med. 2012;366(7):591–600.
Acknowledgments
We would like to extend special thank you to Roland McFarland, Dorota Kaminska, Ph.D., and Lyn Clarito, Pharm.D for their helpful comments on this manuscript. This work was supported by Merit Review Award # I01 BX000273-07 from the United States Department of Veterans Affairs, by NINDS (grant UO1 NS074926; CW), and by the James and Debbie Cho Foundation.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer International Publishing AG
About this chapter
Cite this chapter
Keselman, I., Wasterlain, C.G., Niquet, J., Chen, J.W.Y. (2017). Status Epilepticus - Lessons and Challenges from Animal Models. In: Varelas, P., Claassen, J. (eds) Seizures in Critical Care. Current Clinical Neurology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-49557-6_1
Download citation
DOI: https://doi.org/10.1007/978-3-319-49557-6_1
Published:
Publisher Name: Humana Press, Cham
Print ISBN: 978-3-319-49555-2
Online ISBN: 978-3-319-49557-6
eBook Packages: MedicineMedicine (R0)