Serralta Alfonso, Barcia Juan A, Ortiz Pedro, Durán Carmen, Hernández M Eugenia, Alós Manuel
Fundación para la Investigación, Hospital La Fé de Valencia, Spain.
Epilepsy Res. 2006 Jul;70(1):15-26. doi: 10.1016/j.eplepsyres.2006.02.003. Epub 2006 Apr 17.
Two protocols were tested to assess anticonvulsant efficacy and drug concentrations after intracerebroventricular (i.c.v.) continuous valproic acid (VPA) infusion, as compared with acute injections in the kindling epilepsy model. Protocol 1: amygdala-kindled rats were injected via intraperitoneal (i.p.) and i.c.v. routes with varying doses of VPA and tested for seizure intensity, afterdischarge and seizure duration, ataxia and sedation. Concentrations of VPA were determined by immunofluorescence in the brain, plasma, cerebrospinal fluid (CSF) and liver in matching rats. Protocol 2: amygdala-kindled rats were implanted with osmotic minipumps containing a VPA solution in saline and connected to intraventricular catheters for 7 days. Seizure threshold, latency and duration, afterdischarge duration, ataxia and sedation were recorded daily before, during, and until 5 days after VPA infusion. In matching animals, CSF, brain, plasma and liver VPA concentration was determined. Acute i.c.v. VPA injection suppressed seizures with a remarkable ataxia and sedation. However, continuous i.c.v. infusion controlled generalised and even focal seizures without producing important side effects, high plasma levels or hepatic drug concentrations. In conclusion, continuous i.c.v. VPA infusion may protect against kindled seizures by minimising ataxia and sedation, and achieving suitable intracerebral, yet low plasma or hepatic drug concentrations, thus avoiding potential systemic toxicity.
在点燃癫痫模型中,测试了两种方案以评估脑室内(i.c.v.)持续输注丙戊酸(VPA)后的抗惊厥疗效和药物浓度,并与急性注射进行比较。方案1:通过腹腔内(i.p.)和脑室内途径给杏仁核点燃的大鼠注射不同剂量的VPA,并测试其癫痫发作强度、放电后电位和发作持续时间、共济失调和镇静情况。通过免疫荧光法测定匹配大鼠脑、血浆、脑脊液(CSF)和肝脏中的VPA浓度。方案2:给杏仁核点燃的大鼠植入含有VPA生理盐水溶液的渗透微型泵,并连接到脑室内导管7天。在VPA输注前、输注期间及输注后5天每天记录癫痫发作阈值、潜伏期和持续时间、放电后持续时间、共济失调和镇静情况。测定匹配动物的脑脊液、脑、血浆和肝脏中VPA浓度。急性脑室内注射VPA可抑制癫痫发作,但伴有明显的共济失调和镇静。然而,持续脑室内输注可控制全身性甚至局灶性癫痫发作,且不产生重要副作用、高血浆水平或肝脏药物浓度。总之,持续脑室内输注VPA可通过最小化共济失调和镇静,并实现合适的脑内药物浓度,同时降低血浆或肝脏药物浓度,从而避免潜在的全身毒性,来预防点燃性癫痫发作。