Clozapine-induced seizures and EEG abnormalities in ambulatory psychiatric patients

Being motor nerves neurinomas originating from ocular nerves are very rare, unless associated with neurofibromatosis. Authors describe two cases of oculomotor nerve i.e. third nerve, Schwann cell tumours. One of them presented as a cavernous sinus mass in a middle aged lady while the other was a middle aged man with a large cisterno-cavernous tumour. Surgical approach is discussed and the relevant literature reviewed.     

Decreased expression of calmodulin kinase II and calcineurin messenger RNAs in the mouse hippocampus after kainic acid-induced seizures

The Ca2+/calmodulin-dependent protein kinase II (CaMKII) and the phosphatase calcineurin (CaN) are especially abundant in the mammalian CNS, where they have been implicated repeatedly in different neuronal functions. CaMKII is a holoenzyme that is likely to be constituted of both homomultimers and heteromultimers, CaMKIIalpha and CaMKIIbeta being the most abundant subunits in the brain. CaN is a heterodimer constituted of a catalytic subunit (CaN A) and a regulatory subunit (CaN B), and CaN Aalpha is the predominant form in the brain. We studied the expression of CaMKIIalpha, CaMKIIbeta, and CaN Aalpha subunit messenger RNAs in the mouse hippocampus at different times after the administration of a convulsant dose of kainic acid. CaMKIIalpha and CaN A immunohistochemistry was also performed. We observed a transient decrease in the three messenger RNAs in the kainic acid-treated mice, peaking at 5 or 24 h of treatment. The effect had disappeared completely 8 days after treatment. No significant alterations in CaMKII or CaN immunolabelling were observed in the hippocampus of kainic acid-treated mice. The observed modifications could be due to the neuronal hyperexcitability induced by kainic acid rather than neuronal degeneration, because no areas of neuronal loss were detected. Our results suggest that the expression of CaMKII and CaN mRNAs is down-regulated in neuronal cells in response to the hyperexcitability induced by kainic acid. The transient nature of the effect and the apparent absence of significant modifications in the amount of their corresponding proteins may be related to the absence of neuronal damage.     

Glial response to neuronal activity: GFAP-mRNA and protein levels are transiently increased in the hippocampus after seizures

We have recently demonstrated that electrically induced seizures lead to dramatic increases in mRNA for GFAP in areas in which seizures occur. The present study evaluates the time course of the changes in the GFAP-mRNA levels after seizures and the relationship between these changes and GFAP protein levels to understand the role of neuronal activity in regulating glial gene expression. GFA protein and mRNA levels were measured in hippocampi from rats in which seizures were induced by: (1) 50-Hz stimulus trains delivered 12 times over the course of 1 day via indwelling electrodes implanted chronically in the CA3 region of the hippocampus; and (2) intraperitoneal injections of pentylenetetrazol. In the case of the electrically induced seizures, we also compared the glial response in animals that had never experienced a seizure with the response in animals that previously had been kindled but had not experienced a seizure for 30 days. Electrically induced seizures led to rapid transient increases in GFAP-mRNA levels in the hippocampus ipsi- and contralateral to the stimulation. GFAP-mRNA increased about five-fold 1 day after the end of seizure activity and returned to near-control levels by 4 days. There were no detectable increases in GFA protein at 1 day but by 2 days GFA protein levels had increased about two-fold. GFA protein levels remained elevated until 4 days poststimulation and then began to decrease. The responses were similar when seizures were induced in kindled animals, except that the GFAP protein levels remained elevated for somewhat longer.(ABSTRACT TRUNCATED AT 250 WORDS)     

Expression of GABA(A) receptor subunits in the hippocampus of the rat after kainic acid-induced seizures

The GABA(A) receptor is a ligand gated chloride channel consisting of five membrane spanning proteins for which 13 different genes have been identified in the mammalian brain. The present review summarizes recent work from our laboratory on the characterization of the immunocytochemical distribution of these GABA(A) receptor subunits in the rat brain and changes in immunoreactivity and mRNA expression after kainic acid-induced status epilepticus. A heterogeneous distribution of immunoreactive GABA(A) receptor subunits was observed. The most abundant ones were: alpha1, alpha2, alpha4, alpha5, beta2, beta3, gamma2, and delta. Alpha1, beta2, and gamma2 were about equally distributed in all subfields of the hippocampus; alpha4- and delta-subunits were preferentially found in the dentate molecular layer and in CA1; alpha2 was localized to the dentate molecular layer and CA3; alpha5 was found in the dendritic areas of CA1 to CA3; and beta1 was preferentially seen in CA2. Alpha1, beta2, gamma2 and delta were highly concentrated in interneurons. Kainic acid-induced seizures caused acute and chronic changes in the expression of mRNAs and immunoreactive proteins. Acute changes included decreases in alpha2, alpha5, beta1, beta3, gamma2 and delta mRNA levels (by about 25-50%), accompanied by increases (by about 50%) in alpha1, alpha4, and beta2 messages in granule cells (after 6-12 h). Chronic changes, characterized by losses in mRNA and immunoreactive proteins in CA1 and CA3, are undoubtedly due to seizure-related cell damage. However, compensatory expression of alpha2 and beta3 subunits, especially in CA3b/c, was observed. Furthermore, increases in mRNAs and immunoreactive proteins were seen for alpha1, alpha2 alpha4, beta1, beta2, beta3 and gamma2 in granule cells and in the molecular layer of the dentate gyrus at 7-30 days after kainic acid injection. The changes in the expression of GABA(A) receptor subunits, observed in practically all hippocampal subfields, may reflect altered GABA-ergic transmission during development of the epileptic syndrome. Increased expression of GABA(A) receptor subunits in the dendritic field of granule cells and CA3 suggest that GABA-ergic inhibition may be augmented at these levels. However, the lasting preservation of alpha1-, beta2-, and gamma2-subunits in interneurons could provide a basis for augmented inhibition of GABA-ergic interneurons, leading to net disinhibition.     

Delayed development of spontaneous seizures and prolonged convulsive state in rats after massed stimulation of the anterior piriform cortex

We studied the short- and long-term epileptogenic effects of massed stimulation (MS) of the piriform cortex. Sprague-Dawley rats with electrodes implanted bilaterally in the anterior piriform cortex and the dorsal and ventral hippocampi underwent MS: electrical stimulation of the left piriform cortex every 5 min for 6 h (afterdischarge threshold, 60 Hz, 1 ms, 1 s). Animals were retested (5 stimulations) 3-4 times later at different time points to check for the kindled state. Our data showed that MS resulted in delayed development of severe epilepsy. The interval between MS and the first appearance of convulsive response (2 weeks) was characterized by deep refractoriness to seizure (silent period). Unexpectedly, dramatic seizure activity occurred 4-7 weeks after MS. This was manifested by (1) generalized tonic-clonic convulsions with multiple failings, which were elicited repeatedly during retest; (2) frequent progression of elicited generalized convulsions into a prolonged (> 8 min) postictal convulsive state expressed mainly by continuous partial seizures and even new bouts of generalized seizures, and (3) development of mild spontaneous seizures. We found that epileptiform activity predominated in the ventral hippocampus. Mossy fiber sprouting was also most pronounced in this area. We propose that the MS resulted in formation of pathological circuits which involve both piriform cortex and ventral hippocampus and lead to severe epilepsy.     

Selective alterations in binding kinetic parameters and allosteric regulation of N-methyl-D-aspartate receptors after prolonged seizures in the developing rat brain

To investigate the effect of chronic smoke exposure on pulmonary macrophages (PM), the expression of seven different surface and intracellular molecules of PM was studied in induced sputum (IS) samples from healthy volunteers--nine smokers and seven non-smokers. Sputum was induced by inhalation of nebulized saline (3.5% NaCl). Cell viability and total cell counts (TCC) were performed immediately. Cell differentials were determined on May-Grunwald Giemsa-stained cytospin preparations. The PM were immunologically characterized by use of the following monoclonal antibodies: RFD1, RFD7, CD11b, CD54, CD68, CD71 and HLA-DR. The stainings were performed with a three-step, indirect immuno-alkaline phosphate method. Viability and TCC did not differ between the groups. Smokers had a higher percentage of macrophages (P < 0.05) and a lower proportion of neutrophils (P < 0.05). The percentage of macrophages expressing RFD1, HLA-DR, CD71 (P < 0.01 for all) and CD54 (P < 0.05) was significantly lower in smokers, whereas the remaining markers were expressed equally in the two groups. The results indicate that smoking induces a decrease in the expression by PM of surface molecules known to be associated with the antigen-presenting function.     

Focal electroencephalographic abnormalities and computerised tomography findings in children with seizures

Urethral fistulas are an inherent risk of hypospadias repair. Present-day repairs of hypospadias in which redundant skin is held to a minimum limit the applicability of skin flap advancement technique for closure. To avoid altering the cosmesis of the prior hypospadias repair, 51 urethrocutaneous fistulas were closed using a three-layer simple closure technique without urinary diversion. An 80 percent success rate was achieved following the initial closure. A second simple closure of those which failed also succeeded in 80 percent of the cases.     

Brain stem MRI signal abnormalities in CADASIL

BACKGROUND: We recently showed that the severity of MRI signal abnormalities increases with age in CADASIL, an arteriopathy due to mutations of notch 3 gene on chromosome 19. Previous results also suggest that the various hemispheric subcortical areas have a different vulnerability to ischemia in this disease. The distribution of the lesions at the brain stem level has not yet been reported. CASE DESCRIPTIONS: We reviewed the MRIs of 68 affected patients having signal abnormalities in the hemispheric white matter to assess the distribution and clinical consequences of brain stem signal abnormalities in CADASIL. We found hypersignals on T2-weighted images in the brain stem in 45% of the subjects. The pons was more frequently involved (100%) than the mesencephalon (69%) and the medulla (35%). Hyposignals on T1-weighted images, at the brain stem level, were observed only in two thirds of these subjects. The lack of signal abnormalities reaching the brain stem surface and the absence of cerebellar lesions were noteworthy. CONCLUSIONS: Brain stem signal abnormalities observed in CADASIL are found in regions irrigated only by perforating arteries. These results support parallel observations made for CADASIL-associated signal abnormalities in the cerebral hemispheres and emphasize the importance of the angioarchitecture of the cerebral vasculature to explain why a condition characterized by a systemic vessel wall pathology is manifested only as a brain disease.     

Neuronal migration disorders: heterotopic neocortical neurons in CA1 provide a bridge between the hippocampus and the neocortex

Neuronal migration disorders have been involved in various pathologies, including epilepsy, but the properties of the neural networks underlying disorders have not been determined. In the present study, patch clamp recordings were made from intrahippocampal heterotopic as well as from neocortical and hippocampal neurons from brain slices of rats with prenatally methylazoxymethanol-induced cortical malformation. We report that heterotopic neurons have morphometrical parameters and cellular properties of neocortical supragranular neurons and are integrated in both neocortical and hippocampal networks. Thus, stimulation of the white matter induces both antidromic and orthodromic response in heterotopic and neocortical neurons. Stimulation of hippocampal afferents evokes a monosynaptic response in the majority of heterotopic neurons and a polysynaptic all-or-none epileptiform burst in the presence of bicuculline to block gamma-aminobutyric acid type A inhibition. Furthermore, hippocampal paroxysmal activity generated by bath application of bicuculline can spread directly to the neocortex via the heterotopia in methylazoxymethanol-treated but not in naive rats. We conclude that heterotopias form a functional bridge between the limbic system and the neocortex, providing a substrate for pathological conditions.     

Species differences in executive function correlate with hippocampus volume and neocortex ratio across nonhuman primates.

A persistent debate in behavioral research is whether brain size or architecture relates to cognitive performance. A growing body of evidence has demonstrated correlations between brain size and ecological and behavioral tasks. These studies are premised on a causal link between brain size and cognitive function, although this association has little empirical backing. We show, for a set of 46 species from 17 primate genera, that competence on a series of eight executive function cognitive tasks both correlate across tasks and with brain size and architecture across species. Our model selection approach showed that, although several measures of brain component volumes are significantly associated with performance, hippocampus size is the best predictor of overall performance. The best performing model also includes total brain size and relative neocortex size. Additionally, absolute measures are much more predictive of performance than relative measures of brain and brain component size. These results are consistent with the hippocampus' role in learning, and the executive brain (neocortex) being important for problem solving and consolidation. Our findings challenge and extend those of previous analyses by clarifying the relationship between overall brain size and specific regional volumes. They also suggest that commonly used indices of encephalization, such as residuals of brain volume regressed on body size, may confound rather than clarify matters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Apparent absence of aging and gender effects on serotonin 1A receptors in human neocortex and hippocampus

In the last years Cyclospora sp. has been increasingly associated to human intestinal diseases. The first studies have been reported to this parasite as a Cyanobacterium-like body, large Cryptosporidium or coccidian-like body. The ultrastructural characteristic and the "in vitro" sporulation have revealed the existence of oocyst constituted for two sporocysts with two sporozoites per sporocyst. This evidence has allowed its classification as a coccidian within the genus Cyclospora and its designation as a new pathogen species in humans, Cyclospora cayetanensis. Recently phylogenetic analysis based on rDNA sequences suggested that Cyclospora sp. was closely related to the Eimeria genus. The identification, morphological characteristics, clinical evaluation and chemotherapy of the human intestinal disease associated to Cyclospora sp. are commented in the present paper.     

Reversible brainstem auditory evoked potential abnormalities in jaundiced Gunn rats given sulfonamide

Renal transplantation therapy performed for amyloid nephropathy is controversial because of the fatal effects of the disease. Amyloidosis is a relatively frequent disease and is generally associated with familial Mediterranean fever (FMF) in Turkey. Renal transplantation in the treatment of amyloid nephropathy started in January 1985. Till now, 18 (3.2%) renal transplantations have been performed on patients who had amyloid nephropathy. The mean follow-up period was 34.6 months. Fourteen renal grafts still function well (creatinine: 1-3.2 mg/dL). The overall 1-year patient and graft survival rates were 88.9% and 83.0%, respectively. These rates are not statistically different from renal transplantations done for other cases of renal failure. Therefore, patients with end-stage renal failure due to amyloidosis can be considered as appropriate candidates for renal transplantation.     

Spike-wave complexes and fast components of cortically generated seizures. I. Role of neocortex and thalamus

We explored the relative contributions of cortical and thalamic neuronal networks in the generation of electrical seizures that include spike-wave (SW) and polyspike-wave (PSW) complexes. Seizures were induced by systemic or local cortical injections of bicuculline, a gamma-aminobutyric acid-A (GABAA) antagonist, in cats under barbiturate anesthesia. Field potentials and extracellular neuronal discharges were recorded through arrays of eight tungsten electrodes (0.4 or 1 mm apart) placed over the cortical suprasylvian gyrus and within the thalamus. 1) Systemic injections of bicuculline induced SW/PSW seizures in cortex, whereas spindle sequences continued to be present in the thalamus. 2) Cortical suprasylvian injection of bicuculline induced focal paroxysmal single spikes that developed into full-blown seizures throughout the suprasylvian cortex. The seizures were characterized by highly synchronized SW or PSW complexes at 2-4 Hz, interspersed with runs of fast (10-15 Hz) activity. The intracellular aspects of this complex pattern in different types of neocortical neurons are described in the following paper. Complete decortication abolished the seizure, leaving intact thalamic spindles. Injections of bicuculline in the cortex of athalamic cats resulted in similar components as those occurring with an intact thalamus. 3) Injection of bicuculline in the thalamus decreased the frequency of barbiturate spindles and increased the synchrony of spike bursts fired by thalamocortical and thalamic reticular cells but did not induce seizures. Decortication did not modify the effects of bicuculline injection in the thalamus. Our results indicate that the minimal substrate that is necessary for the production of seizures consisting of SW/PSW complexes and runs of fast activity is the neocortex.     

Retention of maze performance inversely correlates with N-methyl-D-aspartate receptor number in hippocampus and frontal neocortex in the rat.

The N-methyl-{d}-aspartate (NMDA) receptor may play a critical role in learning and memory. In the present study, a significant correlation was found between the number of NMDA-displaceable,Na+-independent {l}-[–3H]glutamate binding sites in the hippocampus and neocortex of young rats and the mean number of errors during retention, but not acquisition, in a 14-unit T-maze. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior of the rat after removal of the neocortex and hippocampal formation.

A study with 55 adult male hooded rats showed that after surgical removal of the neocortex and hippocampal formation, Ss retained most of the movement patterns of locomotion, climbing, grooming, feeding, and fighting. However, forepaw immobility during swimming was abolished. Feeding behavior was suppressed temporarily but recovered partially. The distinctive postures of sleep and waking and a circadian rhythm of motor activity were retained. However, behaviors were often not performed at the appropriate time and place. The normal sequence of grooming behavior was disrupted; food hoarding and social behavior were essentially abolished. Removal of the neocortex alone had much the same effect as removal of neocortex and hippocampus together. Removal of hippocampus alone produced only a mild disruption of behavior. It is suggested that ascending nonspecific projections to the cerebral cortex play an important role in the moment-to-moment control of behavior but are not essential for the sleep–waking cycle. (1? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Large dense-core vesicle exocytosis and membrane recycling in the mossy fibre synapses of the rabbit hippocampus during epileptiform seizures

The ultrastructure of the hippocampal mossy fibre layer was studied in ultrathin sections and freeze-fracture preparations of rabbits under deep Nembutal anaesthesia, after recovery from ether anaesthesia, and 40 min after a single injection of methoxypyridoxine, that is, during the second generalized seizure discharge. The giant mossy fibre boutons contain two types of vesicles: evenly distributed, small round clear vesicles (50 nm) and a few scattered large dense-core vesicles (100 nm). In rare instances fusion of dense-core vesicles with the presynaptic membrane was observed. No differences in the morphology of the mossy fibre synapses were found between anaesthetized and unanaesthetized animals. During epileptiform seizures, however, the size and shape of clear and dense-core vesicles varied greatly. The active synaptic zones were covered with large, core-containing omega profiles or bumps and indentations. Only dense-core vesicles seem to undergo exocytosis. A fusion of clear vesicles with presynaptic membrane was not observed. Various explanations for the fact that only dense-core vesicles seem to undergo exocytosis are discussed. The hypothesis is put forward that in the mossy fibre bouton two morphologically and functionally distinct populations of synaptic vesicles exist and that only one of them undergoes visible irreversible exocytosis, whereas the majority, that is, the small vesicles discharge their transmitter by reversible fusion. After MP injection features of membrane retrieval were also prominent. Frequently, at the borders of the active synaptic zones coated membrane convolutes of both pre- and postsynaptic membranes had invaded the terminals as well as the postsynaptic spine. Thus, in contrast to electrical stimulation, the self-sustained seizures allows energy-expensive processes such as extensive membrane internalization to take place during the interictal pauses.     

Electrocardiographic abnormalities in hypothyroidism before and after exercise

Eleven men and 50 women with severe hypothyroidism were studied. All patients had a serum PBI less than 3.0 mug/100 ml, 131I 24 hours uptake less than 13% and a a photomotogram contraction and half relaxation time of 380 msec or more. Before exercise the mean +/- SE heart rate was 68.39 +/- 3.26/min, the PR interval 17.08 +/- 0.37 csec, the QRS voltage (sum of the QRS amplitude in leads I, II and III) 16.44 +/- 0.89 mm (10mm = 1.0 mV) and the T wave amplitude 0.06 +/- 0.15 mm. A significant correlation (p less than 0.05) existed between the PBI values and the QRS voltage. Following exercise there was a significant acceleration of the heart rate (+ 23.39/min, p less than 0.001), shortening of the PR interval (-0.66 csec, p less than 0.02) and T wave elevation (+ 0.40 mm, p less than 0.001). ST segment changes were not observed in any case. Replacement treatment in 7 cases resulted in a significant change in the resting heart rate (+ 11.86/min. p less than 0.025), PR interval (-3.28 mm, p less than 0.025) and T wave height (+ 2.50 mm, p less than 0.01). These findings suggest that exercise may be used in the differentiation between hypothyroidism and coronary heart disease. The theoretical importance of these findings is also discussed. An increase in cardiac energy demands during exercise may be the cause for some of the ECG changes observed on exertion.     

Differentiating the roles of the hippocampus complex and the neocortex in long-term memory storage: Evidence from the study of semantic dementia and Alzheimer's disease.

Several computational models suggest that the hippocampal complex plays a key role in the establishment of new memories, but over time the storage of such memories becomes independent of this region. In support of such models, the authors demonstrate that patients with semantic dementia, who have relative sparing of the hippocampal complex, show a pattern of preserved recent memories and impaired distant memories. In a group study that used the Autobiographical Memory Interview, amnesic patients with Alzheimer's disease showed the more typical temporally graded loss (poor recall of recent memories), whereas patients with semantic dementia showed the reverse pattern. In a single-case study, using the Galton-Crovitz test, a patient with semantic dementia was significantly better at producing autobiographical memories from the most recent 5 years. By contrast, controls provided similarly detailed memories across all time periods back to childhood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acid phosphatases in the human testis after prolonged estrogen treatment

The testes of 2 autopsied adult men and 6 subjects, suffering from prostatic carcinoma, were analysed for acid phosphatase activities, Two of the prostatic patients had been receiving estrogen treatment at least for a year and had completely regressed testes. Testes of other subjects contained well-defined tubules with different spermatogenic cells in abundance. The total acid phosphatase activity, assayed in the homogenate, showed a marked reduction in the testes of estrogen-treated subjects. Enzymes were separated by cellulose chromatography or by gel filtration combined with cellulose chromatography. Three activity peaks were resolved by the former and four by the latter technique, when homogenates of the control testes were used. In contrast, two to three strongly reduced activities could be discerned from the testes of estrogen-treated subjects. The specific activity of each enzyme after fractionation was compared between control and regressed testes. No difference was observed in the activities of enzyme I. Enzyme II was markedly reduced in the regressed testes, but was clearly present. Enzymes III and IV were either totally absent or showed a marked reduction in the regressed testes. It is suggested that a correlation exists between the destruction of germ cells, as a consequence of estrogen treatment, and the marked reduction in the activity of enzymes III and IV.