Alexander Georgia M, Godwin Dwayne W
Department of Neurobiology and Anatomy, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
Epilepsy Res. 2006 Sep;71(1):1-22. doi: 10.1016/j.eplepsyres.2006.05.012. Epub 2006 Jun 19.
Epilepsy is a chronic neurological disorder that has many known types, including generalized epilepsies that involve cortical and subcortical structures. A proportion of patients have seizures that are resistant to traditional anti-epilepsy drugs, which mainly target ion channels or postsynaptic receptors. This resistance to conventional therapies makes it important to identify novel targets for the treatment of epilepsy. Given the involvement of the neurotransmitter glutamate in the etiology of epilepsy, targets that control glutamatergic neurotransmission are of special interest. The metabotropic glutamate receptors (mGluRs) are of a family of eight G-protein-coupled receptors that serve unique regulatory functions at synapses that use the neurotransmitter glutamate. Their distribution within the central nervous system provides a platform for both presynaptic control of glutamate release, as well as postsynaptic control of neuronal responses to glutamate. In recent years, substantial efforts have been made towards developing selective agonists and antagonists which may be useful for targeting specific receptor subtypes in an attempt to harness the therapeutic potential of these receptors. We examine the possibility of intervening at these receptors by considering the specific example of absence seizures, a form of generalized, non-convulsive seizure that involves the thalamus. Views of the etiology of absence seizures have evolved over time from the "centrencephalic" concept of a diffuse subcortical pacemaker toward the "cortical focus" theory in which cortical hyperexcitability leads the thalamus into the 3-4 Hz rhythms that are characteristic of absence seizures. Since the cortex communicates with the thalamus via a massive glutamatergic projection, ionotropic glutamate receptor (iGluR) blockade has held promise, but the global nature of iGluR intervention has precluded the clinical effectiveness of drugs that block iGluRs. In contrast, mGluRs, because they modulate iGluRs at glutamatergic synapses only under certain conditions, may quell seizure activity by selectively reducing hyperactive glutamatergic synaptic communication within the cortex and thalamus without significantly affecting normal response rates. In this article, we review the circuitry and events leading to absence seizure generation within the corticothalamic network, we present a comprehensive review of the synaptic location and function of mGluRs within the thalamus and cerebral cortex, and review the current knowledge of mGluR modulation and seizure generation. We conclude by reviewing the potential advantages of Group II mGluRs, specifically mGluR2, in the treatment of both convulsive and non-convulsive seizures.
癫痫是一种慢性神经疾病,有多种已知类型,包括涉及皮质和皮质下结构的全身性癫痫。一部分患者的癫痫发作对主要作用于离子通道或突触后受体的传统抗癫痫药物具有抗性。对传统疗法的这种抗性使得确定癫痫治疗的新靶点变得很重要。鉴于神经递质谷氨酸参与癫痫的病因,控制谷氨酸能神经传递的靶点特别受关注。代谢型谷氨酸受体(mGluRs)是一个由八个G蛋白偶联受体组成的家族,在使用神经递质谷氨酸的突触中发挥独特的调节功能。它们在中枢神经系统内的分布为谷氨酸释放的突触前控制以及神经元对谷氨酸反应的突触后控制提供了一个平台。近年来,人们在开发选择性激动剂和拮抗剂方面付出了巨大努力,这些药物可能有助于靶向特定受体亚型,以挖掘这些受体的治疗潜力。我们通过考虑失神发作这一具体例子来研究干预这些受体的可能性,失神发作是一种全身性、非惊厥性发作形式,涉及丘脑。随着时间的推移,失神发作病因的观点已从弥漫性皮质下起搏器的“中央脑”概念演变为“皮质焦点”理论,即皮质兴奋性过高导致丘脑进入失神发作特有的3 - 4赫兹节律。由于皮质通过大量谷氨酸能投射与丘脑通信,离子型谷氨酸受体(iGluR)阻断曾被寄予厚望,但iGluR干预的全局性性质排除了阻断iGluR药物的临床有效性。相比之下,mGluRs仅在某些条件下调节谷氨酸能突触处的iGluRs,可能通过选择性降低皮质和丘脑内过度活跃的谷氨酸能突触通信来平息癫痫活动,而不会显著影响正常反应率。在本文中,我们回顾了导致皮质丘脑网络内失神发作产生的神经回路和事件,全面综述了丘脑和大脑皮质内mGluRs的突触定位和功能,并回顾了mGluR调节和癫痫发作产生的现有知识。我们通过回顾II组mGluRs,特别是mGluR2,在治疗惊厥性和非惊厥性发作方面的潜在优势来得出结论。