Distinct fastigial output channels and their impact on temporal lobe seizures

Despite being canonically considered a motor control structure, the cerebellum is increasingly recognized for important roles in processes beyond this traditional framework, including seizure suppression. Excitatory fastigial neurons project to a large number of downstream targets, and it is unclear if this broad targeting underlies seizure suppression, or if a specific output may be sufficient. To address this question, we used the intrahippocampal kainic acid mouse model of temporal lobe epilepsy, male and female animals, and a dual-virus approach to selectively label and manipulate fastigial outputs. We examined fastigial neurons projecting to the superior colliculus, medullary reticular formation, and central lateral nucleus of the thalamus, and found that these comprise largely non-overlapping populations of neurons which send collaterals to unique sets of additional thalamic and brainstem regions, creating distinct, somewhat overlapping, output channels. We found that neither optogenetic stimulation of superior colliculus nor reticular formation output channels attenuated hippocampal seizures. In contrast, on-demand stimulation of fastigial neurons targeting the central lateral nucleus robustly inhibited seizures. Our results indicate that fastigial control of hippocampal seizures does not require simultaneous modulation of many fastigial output channels. Rather, selective modulation of the fastigial output channel to the central lateral thalamus, specifically, is sufficient for seizure control. This may provide a means for more selective therapeutic interventions, which provide seizure control while minimizing unwanted side effects. More broadly, our data highlight the concept of specific cerebellar output channels, whereby discrete cerebellar nucleus neurons project to specific aggregates of downstream targets, with distinct functional outcomes.

Atrioventricular Conduction in Mesial Temporal Lobe Seizures

Purpose: Asymmetric cerebral representation of autonomic function could help to stratify cardiac complications in people with epilepsy, as some seizures are associated with potentially deleterious arrhythmias including bradycardia and atrioventricular (AV) conduction block. We investigated seizure-related changes in AV conduction and ascertained whether these alterations depend on the hemisphere in mesial temporal lobe epilepsy (mTLE).Methods: EEG and ECG data of people with pharmacoresistant mTLE undergoing pre-surgical video-EEG telemetry with seizures independently arising from both hippocampi, as determined by intracranial depths electrodes were reviewed. RR and PR intervals were measured using one-lead ECG. Statistics were done with paired student's t-tests and linear regression analysis. Data are given as mean ± SD.Results: Fifty-six seizures of 14 patients (5 men, age 34.7 ± 9.8 years) were included (2 seizures per hemisphere and patient). There were no differences of absolute PR intervals and HR before and during unilateral ictal activity between left- and right-sided hippocampal seizures. Peri-ictal modulation of AV conduction, however, appeared greater with left-sided seizures, as the slope of the PR/HR correlations was significantly steeper with seizures originating in the left hippocampus. PR lengthening >200 ms or full block did not occur in any seizure.Conclusions: Our data show that on average, PR intervals shortens with mesial temporal lobe seizures with more prominent effects in seizures with left-sided onset, supporting the notion of lateralized cerebral control of cardiac function. The clinical relevance of this subtle finding is unclear but may indicate a lateralized susceptibility to seizure-related AV node dysfunction in mTLE.

Chemicogenetic recruitment of specific interneurons suppresses seizure activity

Enhancing the brain’s endogenous inhibitory mechanisms represents an important strategy for suppressing epileptic discharges. Indeed, drugs that boost synaptic inhibition can disrupt epileptic seizure activity, although these drugs generate complex effects due to the broad nature of their action. Recently developed chemicogenetic techniques provide the opportunity to pharmacologically enhance endogenous inhibitory mechanisms in a more selective manner. Here we use chemicogenetics to assess the anti-epileptic potential of enhancing the synaptic output from three major interneuron populations in the hippocampus: parvalbumin (PV), somatostatin (SST) and vasoactive intestinal peptide (VIP) expressing interneurons. Targeted pre- and post-synaptic whole cell recordings in an in vitro hippocampal mouse model revealed that all three interneuron types increase their firing rate and synaptic output following chemicogenetic activation. However, the interneuron populations exhibited different anti-epileptic effects. Recruiting VIP interneurons resulted in a mixture of pro-epileptic and anti-epileptic effects. In contrast, recruiting SST or PV interneurons produced robust suppression of epileptiform activity. PV interneurons exhibited the strongest effect per cell, eliciting at least a five-fold greater reduction in epileptiform activity than the other cell types. Consistent with this, we found that chemicogenetic recruitment of PV interneurons was effective in an in vivo mouse model of hippocampal seizures. Following efficient delivery of the chemicogenetic tool, pharmacological enhancement of the PV interneuron population suppressed a range of seizure-related behaviours and prevented generalized seizures. Our findings therefore support the idea that selective chemicogenetic enhancement of synaptic inhibitory pathways offers potential as an anti-epileptic strategy.Significance statementDrugs that enhance synaptic inhibition can be effective anticonvulsants but often cause complex effects due to their widespread action. Here we examined the anti-epileptic potential of recently developed chemicogenetic techniques, which offer a way to selectively enhance the synaptic output of distinct types of inhibitory neurons. A combination of in vitro and in vivo experimental models were used to investigate seizure activity in the mouse hippocampus. We find that chemicogenetically recruiting the parvalbumin-expressing population of inhibitory neurons produces the strongest anti-epileptic effect per cell, and that recruiting this cell population can suppress a range of epileptic behaviours in vivo. The data therefore support the idea that targeted chemicogenetic enhancement of synaptic inhibition offers promise for developing new treatments.

Amygdala and hippocampus are symptomatogenic zones for central apneic seizures

Objective:To identify limbic sites of respiratory control in the human brain, and by extension, the symptomatogenic zone for central apnea.Methods:We used direct stimulation of anatomically, precisely placed stereotactic EEG electrodes to analyze breathing responses. We prospectively studied 3 patients who were explored with stereotactically implanted depth electrodes. The amygdala and hippocampus, as well as extralimbic sites (orbitofrontal, temporal tip, and temporal neocortex), were investigated.Results:Individual stimulation of the amygdala and hippocampal head consistently elicited central apnea in the expiratory phase, as did exquisitely focal hippocampal seizures.Conclusions:These findings confirm that hippocampus and amygdala are limbic breathing control sites in humans, as well as the symptomatogenic zone for central apneic seizures.

Review: Cav2.3 R-type Voltage-Gated Ca2+ Channels - Functional Implications in Convulsive and Non-convulsive Seizure Activity

Background: Researchers have gained substantial insight into mechanisms of synaptic transmission, hyperexcitability, excitotoxicity and neurodegeneration within the last decades. Voltage-gated Ca2+ channels are of central relevance in these processes. In particular, they are key elements in the etiopathogenesis of numerous seizure types and epilepsies. Earlier studies predominantly targeted on Cav2.1 P/Q-type and Cav3.2 T-type Ca2+ channels relevant for absence epileptogenesis. Recent findings bring other channels entities more into focus such as the Cav2.3 R-type Ca2+ channel which exhibits an intriguing role in ictogenesis and seizure propagation. Cav2.3 R-type voltage gated Ca2+ channels (VGCC) emerged to be important factors in the pathogenesis of absence epilepsy, human juvenile myoclonic epilepsy (JME), and cellular epileptiform activity, e.g. in CA1 neurons. They also serve as potential target for various antiepileptic drugs, such as lamotrigine and topiramate. Objective: This review provides a summary of structure, function and pharmacology of VGCCs and their fundamental role in cellular Ca2+ homeostasis. We elaborate the unique modulatory properties of Cav2.3 R-type Ca2+ channels and point to recent findings in the proictogenic and proneuroapoptotic role of Cav2.3 R-type VGCCs in generalized convulsive tonic–clonic and complex-partial hippocampal seizures and its role in non-convulsive absence like seizure activity. Conclusion: Development of novel Cav2.3 specific modulators can be effective in the pharmacological treatment of epilepsies and other neurological disorders.