Institute of Neurophysiology, Charité Universitätsmedizin Berlin, Berlin, Germany.
Epilepsia. 2011 Jan;52(1):94-103. doi: 10.1111/j.1528-1167.2010.02722.x. Epub 2010 Sep 24.
Seizure-like events (SLEs) induced by 4-aminopyridine in rat organotypic slices cultures, which are prepared early after birth, are resistant to standard antiepileptic drugs. In this study we tested the hypothesis that pharmacoresistance may be an intrinsic property of the immature brain.
Frequently recurring SLEs presumably representing status epilepticus were induced by 4-aminopyridine in acute rat hippocampal-entorhinal cortex slices obtained from postnatal day 3-19 (P3-P19), and the effects of carbamazepine, phenytoin, valproic acid, and phenobarbital were examined. In addition, bumetanide was tested, which blocks the Na(+) -K(+) -2Cl(-) (NKCC1) cotransporter, and also acetazolamide, which blocks the carbonic anhydrase and thereby the accumulation of bicarbonate inside neurons.
The efficacy of all antiepileptic drugs in blocking SLEs was dependent on postnatal age, with low efficacy in P3-P5 slices. Antiepileptic drugs suppressed SLEs more readily in the medial entorhinal cortex (ECm) than in the CA3. In P3-P5 slices, valproic acid and phenobarbital increased both tonic and clonic seizure-like activities in the CA3, whereas phenytoin and carbamazepine blocked tonic-like but prolonged clonic-like activity. In P3-P5 slices, bumetanide often blocked SLEs in the CA3, but was not as effective in the ECm. Like with other antiepileptic drugs, the seizure-suppressing effects of acetazolamide increased with postnatal age.
We conclude that pharmacoresistance may be inherent to very immature tissue and suggest that expression of the NKCC1 cotransporter might contribute to pharmacoresistance.
在新生后早期制备的大鼠器官型切片培养物中,4-氨基吡啶诱导的癫痫样发作(SLE)对标准抗癫痫药物有抗性。在这项研究中,我们检验了这样一种假设,即药物抗性可能是未成熟大脑的固有特性。
通过在从出生后第 3 天到第 19 天(P3-P19)获得的急性大鼠海马-内嗅皮层切片中使用 4-氨基吡啶,诱导频繁出现的 SLE,推测代表癫痫持续状态,并检查了卡马西平、苯妥英、丙戊酸钠和苯巴比妥的作用。此外,还测试了布美他尼,它阻断 Na(+) -K(+) -2Cl(-)(NKCC1)共转运体,以及乙酰唑胺,它阻断碳酸酐酶,从而使神经元内的碳酸氢盐积累。
所有抗癫痫药物阻断 SLE 的效果都依赖于出生后的年龄,在 P3-P5 切片中效果较低。抗癫痫药物在抑制 SLE 方面在 medial entorhinal cortex(ECm)比在 CA3 中更有效。在 P3-P5 切片中,丙戊酸钠和苯巴比妥增加了 CA3 中的强直和阵挛性癫痫样活动,而苯妥英和卡马西平阻断了强直样但延长了阵挛样活动。在 P3-P5 切片中,布美他尼通常可以阻断 CA3 中的 SLE,但在 ECm 中效果不佳。与其他抗癫痫药物一样,乙酰唑胺的抗惊厥作用随着出生后的年龄而增加。
我们得出结论,药物抗性可能是非常不成熟组织所固有的,并表明 NKCC1 共转运体的表达可能有助于药物抗性。