Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The ...Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression,protein expression,ion channel activity,energy metabolites,and gut microbiota composition.Satisfactory results are lacking for conventional treatments for epilepsy.Surgical resection of lesions,drug therapy,and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy.Non-pharmacological treatments,such as a ketogenic diet,gene therapy for nerve regeneration,and neural regulation,are currently areas of research focus.This review provides a comprehensive overview of the pathogenesis,diagnostic methods,and treatments of epilepsy.It also elaborates on the theoretical basis,treatment modes,and effects of invasive nerve stimulation in neurotherapy,including percutaneous vagus nerve stimulation,deep brain electrical stimulation,repetitive nerve electrical stimulation,in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation.Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures.Additionally,many new technologies for the diagnosis and treatment of epilepsy are being explored.However,current research is mainly focused on analyzing patients’clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level,which has led to a lack of consensus regarding the mechanisms related to the disease.展开更多
Current treatments for epilepsy can only manage the symptoms of the condition but cannot alter the initial onset or halt the progression of the disease. Consequently, it is crucial to identify drugs that can target no...Current treatments for epilepsy can only manage the symptoms of the condition but cannot alter the initial onset or halt the progression of the disease. Consequently, it is crucial to identify drugs that can target novel cellular and molecular mechanisms and mechanisms of action. Increasing evidence suggests that axon guidance molecules play a role in the structural and functional modifications of neural networks and that the dysregulation of these molecules is associated with epilepsy susceptibility. In this review, we discuss the essential role of axon guidance molecules in neuronal activity in patients with epilepsy as well as the impact of these molecules on synaptic plasticity and brain tissue remodeling. Furthermore, we examine the relationship between axon guidance molecules and neuroinflammation, as well as the structural changes in specific brain regions that contribute to the development of epilepsy. Ample evidence indicates that axon guidance molecules, including semaphorins and ephrins, play a fundamental role in guiding axon growth and the establishment of synaptic connections. Deviations in their expression or function can disrupt neuronal connections, ultimately leading to epileptic seizures. The remodeling of neural networks is a significant characteristic of epilepsy, with axon guidance molecules playing a role in the dynamic reorganization of neural circuits. This, in turn, affects synapse formation and elimination. Dysregulation of these molecules can upset the delicate balance between excitation and inhibition within a neural network, thereby increasing the risk of overexcitation and the development of epilepsy. Inflammatory signals can regulate the expression and function of axon guidance molecules, thus influencing axonal growth, axon orientation, and synaptic plasticity. The dysregulation of neuroinflammation can intensify neuronal dysfunction and contribute to the occurrence of epilepsy. This review delves into the mechanisms associated with the pathogenicity of axon guidance molecules in epilepsy, offering a valuable reference for the exploration of therapeutic targets and presenting a fresh perspective on treatment strategies for this condition.展开更多
BACKGROUND Gamma-aminobutyric acid type A receptor has long been acknowledged as a key target in the pathophysiology of epilepsy.The GABRA1 and GABRG2 genes encode the α1 and γ2 subunits of the gamma-aminobutyric ac...BACKGROUND Gamma-aminobutyric acid type A receptor has long been acknowledged as a key target in the pathophysiology of epilepsy.The GABRA1 and GABRG2 genes encode the α1 and γ2 subunits of the gamma-aminobutyric acid type A receptor,a key protein implicated in the development of epilepsy.However,the specific association of the GABRA1 IVS11+15 A>G rs2279020 and GABRG2 G3145A rs211013 polymorphisms with antiepileptic drug resistance has been elucidated in only a limited number of investigations.AIM To elucidate the association between GABRA1 IVS11+15 A>G rs2279020 and GABRG2 G3145A rs211013 gene mutations and drug resistance in epilepsy patients.METHODS A total of 100 epilepsy patients(50 drug responsive and 50 drug resistant subjects)were recruited and rs2279020-and rs211013-polymorphism analyzed by restriction fragment length polymorphism-polymerase chain reaction technique.RESULTS For GABRA1 rs2279020 polymorphism,AG genotype exhibited risk association with an odds ratio of 0.966(95%confidence interval=0.346-2.698)with P value=0.948;however,this association did not achieve statistical significance(P=0.948).Additionally,a higher risk association was identified with the GG genotype,with an odds ratio of 1.808(P=0.382).GABRG2 rs211013 polymorphism revealed no significant association with drug resistance.CONCLUSION The GABRA1 rs2279020 genetic variation is associated with an increased risk for the AG and GG variants,although this association was not statistically significant.Limited investigations have explored the relevance of genetic variations in epilepsy and drug resistance.Longitudinal research is needed to better understand their significance in epilepsy management and to optimize therapeutic strategies.展开更多
[Objectives]To observe the clinical effect of Tiaoqi Dingxian prescription combined with western medicine on epilepsy of qi constraint and phlegm stagnation type.[Methods]A total of 60 cases of patients of epilepsy of...[Objectives]To observe the clinical effect of Tiaoqi Dingxian prescription combined with western medicine on epilepsy of qi constraint and phlegm stagnation type.[Methods]A total of 60 cases of patients of epilepsy of qi constraint and phlegm stagnation type admitted to Maoming Hospital Affiliated to Guangzhou University of Chinese Medicine from June 2023 to July 2024 were selected as the research subjects.They were randomly divided into the control group and the observation group using a random number table method,with 30 cases in each group.The control group was treated with levetiracetam,while the observation group was treated with Tiaoqi Dingxian prescription on the basis of the control group.Both groups were treated for 3 months,and the clinical efficacy,frequency and duration of epilepsy onset,improvement of electroencephalogram(EEG),Quality of Life in Epilepsy Inventory(QOLIE-31)scores,traditional Chinese medicine(TCM)syndrome scores,and incidence of adverse reactions were evaluated in both groups.[Results]The total effective rate in the observation group was 93.33%(28/30),compared to 73.33%(22/30)in the control group,with a statistically significant difference(P<0.05).Following treatment,the frequency and duration of epilepsy onset in both groups were decreased when compared to the pre-treatment period(P<0.05),and the frequency and duration of epilepsy onset in the observation group were lower than those in the control group(P<0.05).Following treatment,the EEG grading of both groups was improved when compared with that before treatment(P<0.05),and the EEG grading in the observation group was better than that in the control group(P<0.05).Following treatment,the QOLIE-31 scores in both groups,including epilepsy-related concerns,overall health,emotional health,energy,cognitive function,drug effects,and social function,were increased when compared to the scores recorded prior to treatment(P<0.05),and all scores in the observation group were higher than those in the control group(P<0.05).Following treatment,the TCM syndrome scores in both groups were decreased when compared to those prior to treatment(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).The incidence of adverse reactions was observed to be 6.67%(2/30)in the observation group and 13.33%(4/30)in the control group,with no significant difference between the two groups(P>0.05).[Conclusions]The combination of Tiaoqi Dingxian prescription and levetiracetam in the treatment of epilepsy of qi constraint and phlegm stagnation type can improve clinical efficacy,alleviate patient s symptoms and quality of life,and has good safety.展开更多
BACKGROUND The NaV1.1 sodium channel alpha subunit,encoded by SCN1A,is crucial for initiating and propagating action potentials in neurons.SCN1A gene has long been an established target in the etiology and therapy of ...BACKGROUND The NaV1.1 sodium channel alpha subunit,encoded by SCN1A,is crucial for initiating and propagating action potentials in neurons.SCN1A gene has long been an established target in the etiology and therapy of epilepsy.However,very few studies have investigated the relevance of genetic variations in epilepsy and anti-epileptic drug resistance.AIM To investigate associations between polymorphisms,rs121917953 T/A and rs121918623 C/T,and drug resistance in epilepsy patients in the north Indian population.METHODS A total of 100 age-and sex-matched epilepsy patients(50 drug responsive and 50 drug resistant subjects)were recruited and SCN1A rs121918623 C/T*and rs121917953 T/A*polymorphisms were analyzed by the allele specific-PCR technique.χ^(2)and Fisher’s exact test were used to estimate differences between the distribution of SCN1A rs121918623 and rs121917953 gene polymorphisms among various groups.The association between distinct rs121917953 genotypes and drug resistance was analyzed using logistic regression analysis.RESULTS For the SCN1A rs121917953 T/A*(D188V)polymorphism,a significantly higher proportion of individuals with AT genotype were observed in the drug-resistant group as compared to the drug-responsive group.Additionally,a higher risk association was exhibited by AT genotype for drug resistance with an odds ratio of 3.51 and P value=0.017.For the SCN1A rs121918623 C/T*(T875M)polymorphism,no significant difference in genotype distribution was observed between the drug-resistant and drug-sensitive groups.CONCLUSION Our findings indicate that the SCN1A polymorphism D188V is associated with a higher risk of drug resistance for the AT variant as compared to the homozygous TT wild-type.Further research is needed at the functional level and in larger cohorts to determine the potential of these genes as a therapeutic target in epilepsy subjects.展开更多
There is growing evidence that interleukin(IL)-6 plays an important role in neurological and psychiatric disorders.This editorial comments on the study published in the recent issue of the World Journal of Psychiatry,...There is growing evidence that interleukin(IL)-6 plays an important role in neurological and psychiatric disorders.This editorial comments on the study published in the recent issue of the World Journal of Psychiatry,which employed Mendelian randomization to identify a causal relationship between IL-6 receptor blockade and decreased epilepsy incidence.The purpose of this editorial is to highlight the dual effects of IL-6 in epilepsy and its related neuropsychiatric comorbidities.IL-6 plays a critical role in the facilitation of epileptogenesis and maintenance of epileptic seizures and is implicated in neuroinflammatory proce-sses associated with epilepsy.Furthermore,IL-6 significantly influences mood regulation and cognitive dysfunction in patients with epilepsy,highlighting its involvement in neuropsychiatric comorbidities.In summary,IL-6 is not only a pivotal factor in the pathogenesis of epilepsy but also significantly contributes to the emergence of epilepsy-related neuropsychiatric complications.Future resear-ch should prioritize elucidating the specific mechanisms by which IL-6 operates across different subtypes,stages and neuropsychiatric comorbidities of epilepsy,with the aim of developing more precise and effective interventions.Furthermore,the potential of IL-6 as a biomarker for the early diagnosis and prognosis of epile-psy warrants further investigation.展开更多
Epilepsy is a leading cause of disability and mortality worldwide. However, despite the availability of more than 20 antiseizure medications, more than one-third of patients continue to experience seizures. Given the ...Epilepsy is a leading cause of disability and mortality worldwide. However, despite the availability of more than 20 antiseizure medications, more than one-third of patients continue to experience seizures. Given the urgent need to explore new treatment strategies for epilepsy, recent research has highlighted the potential of targeting gliosis, metabolic disturbances, and neural circuit abnormalities as therapeutic strategies. Astrocytes, the largest group of nonneuronal cells in the central nervous system, play several crucial roles in maintaining ionic and energy metabolic homeostasis in neurons, regulating neurotransmitter levels, and modulating synaptic plasticity. This article briefly reviews the critical role of astrocytes in maintaining balance within the central nervous system. Building on previous research, we discuss how astrocyte dysfunction contributes to the onset and progression of epilepsy through four key aspects: the imbalance between excitatory and inhibitory neuronal signaling, dysregulation of metabolic homeostasis in the neuronal microenvironment, neuroinflammation, and the formation of abnormal neural circuits. We summarize relevant basic research conducted over the past 5 years that has focused on modulating astrocytes as a therapeutic approach for epilepsy. We categorize the therapeutic targets proposed by these studies into four areas: restoration of the excitation–inhibition balance, reestablishment of metabolic homeostasis, modulation of immune and inflammatory responses, and reconstruction of abnormal neural circuits. These targets correspond to the pathophysiological mechanisms by which astrocytes contribute to epilepsy. Additionally, we need to consider the potential challenges and limitations of translating these identified therapeutic targets into clinical treatments. These limitations arise from interspecies differences between humans and animal models, as well as the complex comorbidities associated with epilepsy in humans. We also highlight valuable future research directions worth exploring in the treatment of epilepsy and the regulation of astrocytes, such as gene therapy and imaging strategies. The findings presented in this review may help open new therapeutic avenues for patients with drugresistant epilepsy and for those suffering from other central nervous system disorders associated with astrocytic dysfunction.展开更多
BACKGROUND Malnutrition and epilepsy share a complex bidirectional relationship,with malnutrition serving as a potential risk factor for epilepsy development,while epilepsy,in turn,often exerts profound effects on nut...BACKGROUND Malnutrition and epilepsy share a complex bidirectional relationship,with malnutrition serving as a potential risk factor for epilepsy development,while epilepsy,in turn,often exerts profound effects on nutritional status.Nutritional interventions have emerged as a critical adjunctive approach in epilepsy management.AIM To explore the multifaceted associations between malnutrition and epilepsy,structured into three primary sections:(1)Elucidating the impact of malnutrition as a risk factor for epilepsy onset;(2)Examining the reciprocal influence of epilepsy on nutritional status,and(3)Evaluating diverse nutritional interventions in the management of epilepsy.METHODS A systematic search was conducted across PubMed,Scopus,and Web of Science databases utilizing defined keywords related to malnutrition,epilepsy,and nutritional interventions.Inclusion criteria encompassed various study types,including clinical trials,animal models,cohort studies,case reports,meta-analyses,systematic reviews,guidelines,editorials,and review articles.Four hundred sixteen pertinent references were identified,with 198 review articles,153 research studies,21 case reports,24 meta-analyses,14 systematic reviews,4 guidelines,and 2 editorials meeting the predefined criteria.RESULTS The review revealed the intricate interplay between malnutrition and epilepsy,highlighting malnutrition as a potential risk factor in epilepsy development and elucidating how epilepsy often leads to nutritional deficiencies.Findings underscored the importance of nutritional interventions in managing epilepsy,showing their impact on seizure frequency,neuronal function,and overall brain health.CONCLUSION This systematic review emphasizes the bidirectional relationship between malnutrition and epilepsy while emphasizing the critical role of nutritional management in epilepsy treatment.The multifaceted insights underscore the need for a holistic approach to addressing nutritional aspects alongside conventional epilepsy management strategies.展开更多
Epilepsy is a long-term neurological condition marked by recurrent seizures,which result from abnormal electrical activity in the brain that disrupts its normal functioning.Traditional methods for detecting epilepsy t...Epilepsy is a long-term neurological condition marked by recurrent seizures,which result from abnormal electrical activity in the brain that disrupts its normal functioning.Traditional methods for detecting epilepsy through machine learning typically utilize discrete-time models,which inadequately represent the continuous dynamics of electroencephalogram(EEG)signals.To overcome this limitation,we introduce an innovative approach that employs Neural Ordinary Differential Equations(NODEs)to model EEG signals as continuous-time systems.This allows for effective management of irregular sampling and intricate temporal patterns.In contrast to conventional techniques,such as Convolutional Neural Networks(CNNs)and Recurrent Neural Networks(RNNs),which necessitate fixedlength inputs and often struggle with long-term dependencies,our framework incorporates:(1)a NODE block to capture continuous-time EEG dynamics,(2)a feature extraction module tailored for seizure-specific patterns,and(3)an attention-based fusion mechanism to enhance interpretability in classification.When evaluated on three publicly accessible EEG datasets,including those from Boston Children’s Hospital and the Massachusetts Institute of Technology(CHB-MIT)and the Temple University Hospital(TUH)EEG Corpus,the model demonstrated an average accuracy of 98.2%,a sensitivity of 97.8%,a specificity of 98.3%,and an F1-score of 97.9%.Additionally,the inference latency was reduced by approximately 30%compared to standard CNN and Long Short-Term Memory(LSTM)architectures,making it well-suited for real-time applications.The method’s resilience to noise and its adaptability to irregular sampling enhance its potential for clinical use in real-time settings.展开更多
Background:Besides seizures,a myriad of overlapping neuropsychiatric and cognitive comorbidities occur in patients with epilepsy,which further debilitates their quality of life.This study provides an in-depth characte...Background:Besides seizures,a myriad of overlapping neuropsychiatric and cognitive comorbidities occur in patients with epilepsy,which further debilitates their quality of life.This study provides an in-depth characterization of the impact of brivaracetam and rufinamide individually and in combination at 10 and 20 mg/kg doses,respec-tively,on corneal kindling-induced generalized seizures and behavioral alterations.Furthermore,observed convulsive frequency and behavioral changes were corre-lated to post-kindling-induced changes in the activity of markers of oxidative stress.Methods:Adult C57BL/6 mice were kindled via twice-daily transcorneal 50-Hz elec-trical stimulations(3 mA)for 3 s for 12 days until animals reached a fully kindled state.After the kindling procedure,animals were tested using a set of behavioral tests,and neurochemical alterations were assessed.Results:Corneal-kindled animals exhibited intense generalized convulsions,altered behavioral phenotypes typified by positive symptoms(hyperlocomotion),negative symptoms(anxiety and anhedonia),and deficits in semantic and working memory.BRV 10+RFM 20 dual regime increased convulsive threshold and propensity toward the start of stage 4–5 seizures and improved phenotypical deficits,that is,anxiety,depression,and memory impairments.Moreover,this combination therapy mitigated kindling-induced redox impairments as evidenced by reduced malondialdehyde and acetylcholinesterase levels and increased glutathione antioxidant activity in the brain of animals subjected to repetitive brain insult.Conclusion:Based on our outcomes,this dual therapy provides supporting evidence in alleviating epilepsy-induced neurobehavioral comorbidities and changes in redox homeostasis.展开更多
Epilepsy is a devastating neurological condition that affects over 70 million people worldwide.Apart from idiopathic epilepsy,numerous diseases have been reported to cause secondary epilepsy.Polyphenols,ubiquitously e...Epilepsy is a devastating neurological condition that affects over 70 million people worldwide.Apart from idiopathic epilepsy,numerous diseases have been reported to cause secondary epilepsy.Polyphenols,ubiquitously existing in fruits and vegetables,has become a promising neuroprotective candidate against multiple neurological abnormalities due to its interplay with gut microbiome composed of the bacterial population in gastrointestinal system.This bioactive compound is also being tested for the management of epileptogenesis.However,there is still insufficient evidence from mechanistic studies to demonstrate the causal relationship between anti-epileptic effect of polyphenols and microbial alteration.In this review,we provide the brief overview of epilepsy,polyphenols and gut microbiota.We then analysis the association of polyphenols and gut microbiota particularly in the epilepsy and symptomatic seizures-induced by epilepsy related disorders.We also discuss the possibility for the combined application with probiotics to improve the bioavailability and bioaccessibility of polyphenols for expanding its anti-epileptic function.We finally summarize the therapeutic potential of anti-seizure polyphenols through affecting gut microbiome,and propose that the anti-epileptic effect of polyphenols may be tightly relevant to intestinal bacterial flora for overcoming epilepsy and its comorbidities simultaneously.Therefore,the dietary polyphenols targeting specific bacteria may achieve the outcome of‘one stone,two birds’.展开更多
Complex genetic architecture is the major cause of heterogeneity in epilepsy,which poses challenges for accurate diagnosis and precise treatment.A large number of epilepsy candidate genes have been identified from cli...Complex genetic architecture is the major cause of heterogeneity in epilepsy,which poses challenges for accurate diagnosis and precise treatment.A large number of epilepsy candidate genes have been identified from clinical studies,particularly with the widespread use of next-generation sequencing.Validating these candidate genes is emerging as a valuable yet challenging task.Drosophila serves as an ideal animal model for validating candidate genes associated with neurogenetic disorders such as epilepsy,due to its rapid reproduction rate,powerful genetic tools,and efficient use of ethological and electrophysiological assays.Here,we systematically summarize the advantageous techniques of the Drosophila model used to investigate epilepsy genes,including genetic tools for manipulating target gene expression,ethological assays for seizure-like behaviors,electrophysiological techniques,and functional imaging for recording neural activity.We then introduce several typical strategies for identifying epilepsy genes and provide new insights into gene-gene interactions in epilepsy with polygenic causes.We summarize well-established precision medicine strategies for epilepsy and discuss prospective treatment options,including drug therapy and gene therapy for genetic epilepsy based on the Drosophila model.Finally,we also address genetic counseling and assisted reproductive technology as potential approaches for the prevention of genetic epilepsy.展开更多
Background:Epilepsy is a disease characterized by unprovoked seizures,and it affects around 70 million people worldwide.Standard treatment is ineffective in one third of all epilepsy patients.Temporal Lobe Epilepsy wi...Background:Epilepsy is a disease characterized by unprovoked seizures,and it affects around 70 million people worldwide.Standard treatment is ineffective in one third of all epilepsy patients.Temporal Lobe Epilepsy with Hippocampal Sclerosis(TLE-HS)is the most drug-resistant form of epilepsy,and it also impacts physical,mental,and psychological well-being of patients.Carum carvi extract has demonstrated anti-convulsant,anti-depressant,and anxiolytic properties.This study was designed to investigate if Carum carvi extract can alleviate depression and memory loss symptoms in a TLE-HS animal model.Methods:Male Sprague Dawley rats were used to create a model of TLE-HS and Carum carvi extract treatment,along with appropriate controls,was used to test the efficacy of this herbal extract in reducing the symptoms of depression and memory loss.Results:Forced swim test showed that Carum carvi extract treated TLE-HS rats resulted in significant improvement of the symptoms of depression.However,novel object recognition test showed that memory improvement did not occur.Conclusion:Depression significantly impacts the quality of life in TLE-HS patients,and this study has shown that Carum carvi extract should be explored further as an adjuvant treatment for TLE-HS patients to improve their quality of life.展开更多
Epilepsy affects over 50 million people worldwide.Drug-resistant epilepsy(DRE)accounts for up to a third of these cases,and neuro-inflammation is thought to play a role in such cases.Despite being a long-debated issue...Epilepsy affects over 50 million people worldwide.Drug-resistant epilepsy(DRE)accounts for up to a third of these cases,and neuro-inflammation is thought to play a role in such cases.Despite being a long-debated issue in the field of DRE,the mechanisms underlying neuroinflammation have yet to be fully elucidated.The pro-inflammatory microenvironment within the brain tissue of people with DRE has been probed using single-cell multimodal transcriptomics.Evidence suggests that inflammatory cells and pro-inflammatory cytokines in the nervous system can lead to extensive biochemical changes,such as connexin hemichannel excitability and disruption of neurotransmitter homeostasis.The presence of inflammation may give rise to neuronal network abnormalities that suppress endogenous antiepileptic systems.We focus on the role of neuroinflammation and brain network anomalies in DRE from multiple perspectives to identify critical points for clinical application.We hope to provide an insightful overview to advance the quest for better DRE treatments.展开更多
Approximately 30%-40% of epilepsy patients do not respond well to adequate anti-seizure medications(ASMs),a condition known as pharmacoresistant epilepsy.The management of pharmacoresistant epilepsy remains an intract...Approximately 30%-40% of epilepsy patients do not respond well to adequate anti-seizure medications(ASMs),a condition known as pharmacoresistant epilepsy.The management of pharmacoresistant epilepsy remains an intractable issue in the clinic.Its early prediction is important for prevention and diagnosis.However,it still lacks effective predictors and approaches.Here,a classical model of pharmacoresistant temporal lobe epilepsy(TLE)was established to screen pharmacoresistant and pharmaco-responsive individuals by applying phenytoin to amygdaloid-kindled rats.Ictal electroencephalograms(EEGs)recorded before phenytoin treatment were analyzed.Based on ictal EEGs from pharmacoresistant and pharmaco-responsive rats,a convolutional neural network predictive model was constructed to predict pharmacoresistance,and achieved 78% prediction accuracy.We further found the ictal EEGs from pharmacoresistant rats have a lower gamma-band power,which was verified in seizure EEGs from pharmacoresistant TLE patients.Prospectively,therapies targeting the subiculum in those predicted as“pharmacoresistant”individual rats significantly reduced the subsequent occurrence of pharmacoresistance.These results demonstrate a new methodology to predict whether TLE individuals become resistant to ASMs in a classic pharmacoresistant TLE model.This may be of translational importance for the precise management of pharmacoresistant TLE.展开更多
BACKGROUND Epilepsy is a prevalent chronic neurological disorder affecting 50 million individuals globally,with temporal lobe epilepsy(TLE)being the most common form.Despite advances in antiepileptic drug development,...BACKGROUND Epilepsy is a prevalent chronic neurological disorder affecting 50 million individuals globally,with temporal lobe epilepsy(TLE)being the most common form.Despite advances in antiepileptic drug development,over 30%of patients suffer from drug-resistant epilepsy,which can lead to severe cognitive impairments and adverse psychosocial outcomes.AIM To explore the role of bone marrow mesenchymal stem cell(BMSC)-derived exosomal miR-203 in the regulation of neuroinflammation in a mouse model of epilepsy,providing a theoretical basis for the development of targeted microRNA delivery therapies for drug-resistant epilepsy.METHODS Adult male C57BL/6 mice were divided into a control group and a TLE model of 30 mice each,and the TLE model group was established by injecting kainic acid.BMSCs were isolated from the mice,and exosomes were purified using ultracentrifugation.Exosomal miR-203 was identified and characterized using highthroughput sequencing and quantitative reverse-transcription polymerase chain reaction.The uptake of exosomes by hippocampal neurons and the subsequent effects on neuroinflammatory markers were assessed using in vitro cell culture models.RESULTS Exosomal miR-203 exhibited a significant upregulation in BMSCs derived from epileptic mice.In vitro investigations demonstrated the efficient internalization of these exosomes by hippocampal neurons,resulting in downregulation of suppressor of cytokine signaling 3 expression and activation of the nuclear factor kappaB pathway,ultimately leading to enhanced secretion of pro-inflammatory cytokines.CONCLUSION Our study identifies exosomal miR-203 as a key regulator of neuroinflammation in a mouse model of epilepsy.The findings suggest that targeting miR-203 may offer a novel therapeutic strategy for epilepsy by modulating the suppression of cytokine signaling 3/nuclear factor kappaB pathway,thus providing a potential avenue for the development of cell-free therapeutics.展开更多
Epilepsy is a serious neurological disorder;however,the effectiveness of current medications is often suboptimal.Recently,stem cell technology has demonstrated remarkable therapeutic potential in addressing various ne...Epilepsy is a serious neurological disorder;however,the effectiveness of current medications is often suboptimal.Recently,stem cell technology has demonstrated remarkable therapeutic potential in addressing various neurological diseases,igniting interest in its applicability for epilepsy treatment.This comprehensive review summarizes different therapeutic approaches utilizing various types of stem cells.Preclinical experiments have explored the use and potential therapeutic effects of mesenchymal stem cells,including genetically modified variants.Clinical trials involving patientderived mesenchymal stem cells have shown promising results,with reductions in the frequency of epileptic seizures and improvements in neurological,cognitive,and motor functions reported.Another promising therapeutic strategy involves neural stem cells.These cells can be cultured outside the body and directed to differentiate into specific cell types.The transplant of neural stem cells has the potential to replace lost inhibitory interneurons,providing a novel treatment avenue for epilepsy.Embryonic stem cells are characterized by their significant capacity for self-renewal and their ability to differentiate into any type of somatic cell.In epilepsy treatment,embryonic stem cells can serve three primary functions:neuron regeneration,the maintenance of cellular homeostasis,and restorative activity.One notable strategy involves differentiating embryonic stem cells intoγ-aminobutyric acidergic neurons for transplantation into lesion sites.This approach is currently undergoing clinical trials and could be a breakthrough in the treatment of refractory epilepsy.Induced pluripotent stem cells share the same genetic background as the donor,thereby reducing the risk of immune rejection and addressing ethical concerns.However,research on induced pluripotent stem cell therapy remains in the preclinical stage.Despite the promise of stem cell therapies for epilepsy,several limitations must be addressed.Safety concerns persist,including issues such as tumor formation,and the low survival rate of transplanted cells remains a significant challenge.Additionally,the high cost of these treatments may be prohibitive for some patients.In summary,stem cell therapy shows considerable promise in managing epilepsy,but further research is needed to overcome its existing limitations and enhance its clinical applicability.展开更多
Neuroinflammation mediated by microglia and oxidative stress play pivotal roles in the development of chronic temporal lobe epilepsy(TLE).We postulated that kainic acid(KA)-Induced status epilepticus triggers microgli...Neuroinflammation mediated by microglia and oxidative stress play pivotal roles in the development of chronic temporal lobe epilepsy(TLE).We postulated that kainic acid(KA)-Induced status epilepticus triggers microglia-dependent inflammation,leading to neuronal damage,a lowered seizure threshold,and the emergence of spontaneous recurrent seizures(SRS).Extensive evidence from our laboratory suggests that dextromethorphan(DM),even in ultra-low doses,has anti-inflammatory and neuroprotective effects in many animal models of neurodegenerative disease.Our results showed that administration of DM(10 ng/kg per day;subcutaneously via osmotic minipump for 4 weeks)significantly mitigated the residual effects of KA,including the frequency of SRS and seizure susceptibility.In addition,DM-treated rats showed improved cognitive function and reduced hippocampal neuronal loss.We found suppressed microglial activation-mediated neuroinflammation and decreased expression of hippocampal gp91^(phox) and p47^(phox) proteins in KA-induced chronic TLE rats.Notably,even after discontinuation of DM treatment,ultra-low doses of DM continued to confer long-term anti-seizure and neuroprotective effects,which were attributed to the inhibition of microglial NADPH oxidase 2 as revealed by mechanistic studies.展开更多
Epilepsy frequently leads to cognitive dysfunction and approaches to treatment remain limited.Although regular exercise effectively improves learning and memory functions across multiple neurological diseases,its appl...Epilepsy frequently leads to cognitive dysfunction and approaches to treatment remain limited.Although regular exercise effectively improves learning and memory functions across multiple neurological diseases,its application in patients with epilepsy remains controversial.Here,we adopted a 14-day treadmill-exercise paradigm in a pilocarpine injection-induced mouse model of epilepsy.Cognitive assays confirmed the improvement of object and spatial memory after endurance training,and electrophysiological studies revealed the maintenance of hippocampal plasticity as a result of physical exercise.Investigations of the mechanisms underlying this effect revealed that exercise protected parvalbumin interneurons,probably via the suppression of neuroinflammation and improved integrity of blood-brain barrier.In summary,this work identified a previously unknown mechanism through which exercise improves cognitive rehabilitation in epilepsy.展开更多
Epilepsy is a common neurological disorder that is primarily treated with antiseizure medications(ASMs).Although dozens of ASMs are available in the clinic,approximately 30%of epileptic patients have medically refract...Epilepsy is a common neurological disorder that is primarily treated with antiseizure medications(ASMs).Although dozens of ASMs are available in the clinic,approximately 30%of epileptic patients have medically refractory seizures;other limitations in most traditional ASMs include poor tolerability and drug-drug interactions.Therefore,there is an urgent need to develop alternative ASMs.Levetiracetam(LEV)is a first-line ASM that is well tolerated,has promising efficacy,and has little drug-drug interaction.Although it is widely accepted that LEV acts through a unique therapeutic target synaptic vesicle protein(SV)2A,the molecular basis of its action remains unknown.Even so,the next-generation SV2A ligands against epilepsy based on the structure of LEV have achieved clinical success.This review highlights the research and development(R&D)process of LEV and its analogs,brivaracetam and padsevonil,to provide ideas and experience for the R&D of novel ASMs.展开更多
基金supported by the National Natural Science Foundation of China,No.32130060(to XG).
文摘Epilepsy is a severe,relapsing,and multifactorial neurological disorder.Studies regarding the accurate diagnosis,prognosis,and in-depth pathogenesis are crucial for the precise and effective treatment of epilepsy.The pathogenesis of epilepsy is complex and involves alterations in variables such as gene expression,protein expression,ion channel activity,energy metabolites,and gut microbiota composition.Satisfactory results are lacking for conventional treatments for epilepsy.Surgical resection of lesions,drug therapy,and non-drug interventions are mainly used in clinical practice to treat pain associated with epilepsy.Non-pharmacological treatments,such as a ketogenic diet,gene therapy for nerve regeneration,and neural regulation,are currently areas of research focus.This review provides a comprehensive overview of the pathogenesis,diagnostic methods,and treatments of epilepsy.It also elaborates on the theoretical basis,treatment modes,and effects of invasive nerve stimulation in neurotherapy,including percutaneous vagus nerve stimulation,deep brain electrical stimulation,repetitive nerve electrical stimulation,in addition to non-invasive transcranial magnetic stimulation and transcranial direct current stimulation.Numerous studies have shown that electromagnetic stimulation-mediated neuromodulation therapy can markedly improve neurological function and reduce the frequency of epileptic seizures.Additionally,many new technologies for the diagnosis and treatment of epilepsy are being explored.However,current research is mainly focused on analyzing patients’clinical manifestations and exploring relevant diagnostic and treatment methods to study the pathogenesis at a molecular level,which has led to a lack of consensus regarding the mechanisms related to the disease.
基金supported by the National Natural Science Foundation of China,Nos. 81760247, 82171450the Scientific Research Foundation for Doctors of the Affiliated Hospital of Zunyi Medical University,No.(2016)14 (all to HH)。
文摘Current treatments for epilepsy can only manage the symptoms of the condition but cannot alter the initial onset or halt the progression of the disease. Consequently, it is crucial to identify drugs that can target novel cellular and molecular mechanisms and mechanisms of action. Increasing evidence suggests that axon guidance molecules play a role in the structural and functional modifications of neural networks and that the dysregulation of these molecules is associated with epilepsy susceptibility. In this review, we discuss the essential role of axon guidance molecules in neuronal activity in patients with epilepsy as well as the impact of these molecules on synaptic plasticity and brain tissue remodeling. Furthermore, we examine the relationship between axon guidance molecules and neuroinflammation, as well as the structural changes in specific brain regions that contribute to the development of epilepsy. Ample evidence indicates that axon guidance molecules, including semaphorins and ephrins, play a fundamental role in guiding axon growth and the establishment of synaptic connections. Deviations in their expression or function can disrupt neuronal connections, ultimately leading to epileptic seizures. The remodeling of neural networks is a significant characteristic of epilepsy, with axon guidance molecules playing a role in the dynamic reorganization of neural circuits. This, in turn, affects synapse formation and elimination. Dysregulation of these molecules can upset the delicate balance between excitation and inhibition within a neural network, thereby increasing the risk of overexcitation and the development of epilepsy. Inflammatory signals can regulate the expression and function of axon guidance molecules, thus influencing axonal growth, axon orientation, and synaptic plasticity. The dysregulation of neuroinflammation can intensify neuronal dysfunction and contribute to the occurrence of epilepsy. This review delves into the mechanisms associated with the pathogenicity of axon guidance molecules in epilepsy, offering a valuable reference for the exploration of therapeutic targets and presenting a fresh perspective on treatment strategies for this condition.
文摘BACKGROUND Gamma-aminobutyric acid type A receptor has long been acknowledged as a key target in the pathophysiology of epilepsy.The GABRA1 and GABRG2 genes encode the α1 and γ2 subunits of the gamma-aminobutyric acid type A receptor,a key protein implicated in the development of epilepsy.However,the specific association of the GABRA1 IVS11+15 A>G rs2279020 and GABRG2 G3145A rs211013 polymorphisms with antiepileptic drug resistance has been elucidated in only a limited number of investigations.AIM To elucidate the association between GABRA1 IVS11+15 A>G rs2279020 and GABRG2 G3145A rs211013 gene mutations and drug resistance in epilepsy patients.METHODS A total of 100 epilepsy patients(50 drug responsive and 50 drug resistant subjects)were recruited and rs2279020-and rs211013-polymorphism analyzed by restriction fragment length polymorphism-polymerase chain reaction technique.RESULTS For GABRA1 rs2279020 polymorphism,AG genotype exhibited risk association with an odds ratio of 0.966(95%confidence interval=0.346-2.698)with P value=0.948;however,this association did not achieve statistical significance(P=0.948).Additionally,a higher risk association was identified with the GG genotype,with an odds ratio of 1.808(P=0.382).GABRG2 rs211013 polymorphism revealed no significant association with drug resistance.CONCLUSION The GABRA1 rs2279020 genetic variation is associated with an increased risk for the AG and GG variants,although this association was not statistically significant.Limited investigations have explored the relevance of genetic variations in epilepsy and drug resistance.Longitudinal research is needed to better understand their significance in epilepsy management and to optimize therapeutic strategies.
文摘[Objectives]To observe the clinical effect of Tiaoqi Dingxian prescription combined with western medicine on epilepsy of qi constraint and phlegm stagnation type.[Methods]A total of 60 cases of patients of epilepsy of qi constraint and phlegm stagnation type admitted to Maoming Hospital Affiliated to Guangzhou University of Chinese Medicine from June 2023 to July 2024 were selected as the research subjects.They were randomly divided into the control group and the observation group using a random number table method,with 30 cases in each group.The control group was treated with levetiracetam,while the observation group was treated with Tiaoqi Dingxian prescription on the basis of the control group.Both groups were treated for 3 months,and the clinical efficacy,frequency and duration of epilepsy onset,improvement of electroencephalogram(EEG),Quality of Life in Epilepsy Inventory(QOLIE-31)scores,traditional Chinese medicine(TCM)syndrome scores,and incidence of adverse reactions were evaluated in both groups.[Results]The total effective rate in the observation group was 93.33%(28/30),compared to 73.33%(22/30)in the control group,with a statistically significant difference(P<0.05).Following treatment,the frequency and duration of epilepsy onset in both groups were decreased when compared to the pre-treatment period(P<0.05),and the frequency and duration of epilepsy onset in the observation group were lower than those in the control group(P<0.05).Following treatment,the EEG grading of both groups was improved when compared with that before treatment(P<0.05),and the EEG grading in the observation group was better than that in the control group(P<0.05).Following treatment,the QOLIE-31 scores in both groups,including epilepsy-related concerns,overall health,emotional health,energy,cognitive function,drug effects,and social function,were increased when compared to the scores recorded prior to treatment(P<0.05),and all scores in the observation group were higher than those in the control group(P<0.05).Following treatment,the TCM syndrome scores in both groups were decreased when compared to those prior to treatment(P<0.05),and the scores in the observation group were lower than those in the control group(P<0.05).The incidence of adverse reactions was observed to be 6.67%(2/30)in the observation group and 13.33%(4/30)in the control group,with no significant difference between the two groups(P>0.05).[Conclusions]The combination of Tiaoqi Dingxian prescription and levetiracetam in the treatment of epilepsy of qi constraint and phlegm stagnation type can improve clinical efficacy,alleviate patient s symptoms and quality of life,and has good safety.
文摘BACKGROUND The NaV1.1 sodium channel alpha subunit,encoded by SCN1A,is crucial for initiating and propagating action potentials in neurons.SCN1A gene has long been an established target in the etiology and therapy of epilepsy.However,very few studies have investigated the relevance of genetic variations in epilepsy and anti-epileptic drug resistance.AIM To investigate associations between polymorphisms,rs121917953 T/A and rs121918623 C/T,and drug resistance in epilepsy patients in the north Indian population.METHODS A total of 100 age-and sex-matched epilepsy patients(50 drug responsive and 50 drug resistant subjects)were recruited and SCN1A rs121918623 C/T*and rs121917953 T/A*polymorphisms were analyzed by the allele specific-PCR technique.χ^(2)and Fisher’s exact test were used to estimate differences between the distribution of SCN1A rs121918623 and rs121917953 gene polymorphisms among various groups.The association between distinct rs121917953 genotypes and drug resistance was analyzed using logistic regression analysis.RESULTS For the SCN1A rs121917953 T/A*(D188V)polymorphism,a significantly higher proportion of individuals with AT genotype were observed in the drug-resistant group as compared to the drug-responsive group.Additionally,a higher risk association was exhibited by AT genotype for drug resistance with an odds ratio of 3.51 and P value=0.017.For the SCN1A rs121918623 C/T*(T875M)polymorphism,no significant difference in genotype distribution was observed between the drug-resistant and drug-sensitive groups.CONCLUSION Our findings indicate that the SCN1A polymorphism D188V is associated with a higher risk of drug resistance for the AT variant as compared to the homozygous TT wild-type.Further research is needed at the functional level and in larger cohorts to determine the potential of these genes as a therapeutic target in epilepsy subjects.
文摘There is growing evidence that interleukin(IL)-6 plays an important role in neurological and psychiatric disorders.This editorial comments on the study published in the recent issue of the World Journal of Psychiatry,which employed Mendelian randomization to identify a causal relationship between IL-6 receptor blockade and decreased epilepsy incidence.The purpose of this editorial is to highlight the dual effects of IL-6 in epilepsy and its related neuropsychiatric comorbidities.IL-6 plays a critical role in the facilitation of epileptogenesis and maintenance of epileptic seizures and is implicated in neuroinflammatory proce-sses associated with epilepsy.Furthermore,IL-6 significantly influences mood regulation and cognitive dysfunction in patients with epilepsy,highlighting its involvement in neuropsychiatric comorbidities.In summary,IL-6 is not only a pivotal factor in the pathogenesis of epilepsy but also significantly contributes to the emergence of epilepsy-related neuropsychiatric complications.Future resear-ch should prioritize elucidating the specific mechanisms by which IL-6 operates across different subtypes,stages and neuropsychiatric comorbidities of epilepsy,with the aim of developing more precise and effective interventions.Furthermore,the potential of IL-6 as a biomarker for the early diagnosis and prognosis of epile-psy warrants further investigation.
基金supported by the National Key Research and Development Program of China,No. 2023YFF0714200 (to CW)the National Natural Science Foundation of China,Nos. 82472038 and 82202224 (both to CW)+3 种基金the Shanghai Rising-Star Program,No. 23QA1407700 (to CW)the Construction Project of Shanghai Key Laboratory of Molecular Imaging,No. 18DZ2260400 (to CW)the National Science Foundation for Distinguished Young Scholars,No. 82025019 (to CL)the Greater Bay Area Institute of Precision Medicine (Guangzhou)(to CW)。
文摘Epilepsy is a leading cause of disability and mortality worldwide. However, despite the availability of more than 20 antiseizure medications, more than one-third of patients continue to experience seizures. Given the urgent need to explore new treatment strategies for epilepsy, recent research has highlighted the potential of targeting gliosis, metabolic disturbances, and neural circuit abnormalities as therapeutic strategies. Astrocytes, the largest group of nonneuronal cells in the central nervous system, play several crucial roles in maintaining ionic and energy metabolic homeostasis in neurons, regulating neurotransmitter levels, and modulating synaptic plasticity. This article briefly reviews the critical role of astrocytes in maintaining balance within the central nervous system. Building on previous research, we discuss how astrocyte dysfunction contributes to the onset and progression of epilepsy through four key aspects: the imbalance between excitatory and inhibitory neuronal signaling, dysregulation of metabolic homeostasis in the neuronal microenvironment, neuroinflammation, and the formation of abnormal neural circuits. We summarize relevant basic research conducted over the past 5 years that has focused on modulating astrocytes as a therapeutic approach for epilepsy. We categorize the therapeutic targets proposed by these studies into four areas: restoration of the excitation–inhibition balance, reestablishment of metabolic homeostasis, modulation of immune and inflammatory responses, and reconstruction of abnormal neural circuits. These targets correspond to the pathophysiological mechanisms by which astrocytes contribute to epilepsy. Additionally, we need to consider the potential challenges and limitations of translating these identified therapeutic targets into clinical treatments. These limitations arise from interspecies differences between humans and animal models, as well as the complex comorbidities associated with epilepsy in humans. We also highlight valuable future research directions worth exploring in the treatment of epilepsy and the regulation of astrocytes, such as gene therapy and imaging strategies. The findings presented in this review may help open new therapeutic avenues for patients with drugresistant epilepsy and for those suffering from other central nervous system disorders associated with astrocytic dysfunction.
文摘BACKGROUND Malnutrition and epilepsy share a complex bidirectional relationship,with malnutrition serving as a potential risk factor for epilepsy development,while epilepsy,in turn,often exerts profound effects on nutritional status.Nutritional interventions have emerged as a critical adjunctive approach in epilepsy management.AIM To explore the multifaceted associations between malnutrition and epilepsy,structured into three primary sections:(1)Elucidating the impact of malnutrition as a risk factor for epilepsy onset;(2)Examining the reciprocal influence of epilepsy on nutritional status,and(3)Evaluating diverse nutritional interventions in the management of epilepsy.METHODS A systematic search was conducted across PubMed,Scopus,and Web of Science databases utilizing defined keywords related to malnutrition,epilepsy,and nutritional interventions.Inclusion criteria encompassed various study types,including clinical trials,animal models,cohort studies,case reports,meta-analyses,systematic reviews,guidelines,editorials,and review articles.Four hundred sixteen pertinent references were identified,with 198 review articles,153 research studies,21 case reports,24 meta-analyses,14 systematic reviews,4 guidelines,and 2 editorials meeting the predefined criteria.RESULTS The review revealed the intricate interplay between malnutrition and epilepsy,highlighting malnutrition as a potential risk factor in epilepsy development and elucidating how epilepsy often leads to nutritional deficiencies.Findings underscored the importance of nutritional interventions in managing epilepsy,showing their impact on seizure frequency,neuronal function,and overall brain health.CONCLUSION This systematic review emphasizes the bidirectional relationship between malnutrition and epilepsy while emphasizing the critical role of nutritional management in epilepsy treatment.The multifaceted insights underscore the need for a holistic approach to addressing nutritional aspects alongside conventional epilepsy management strategies.
基金extend their appreciation to the King Salman Center for Disability Research for funding this work through Research Group No.KSRG-2024-223.
文摘Epilepsy is a long-term neurological condition marked by recurrent seizures,which result from abnormal electrical activity in the brain that disrupts its normal functioning.Traditional methods for detecting epilepsy through machine learning typically utilize discrete-time models,which inadequately represent the continuous dynamics of electroencephalogram(EEG)signals.To overcome this limitation,we introduce an innovative approach that employs Neural Ordinary Differential Equations(NODEs)to model EEG signals as continuous-time systems.This allows for effective management of irregular sampling and intricate temporal patterns.In contrast to conventional techniques,such as Convolutional Neural Networks(CNNs)and Recurrent Neural Networks(RNNs),which necessitate fixedlength inputs and often struggle with long-term dependencies,our framework incorporates:(1)a NODE block to capture continuous-time EEG dynamics,(2)a feature extraction module tailored for seizure-specific patterns,and(3)an attention-based fusion mechanism to enhance interpretability in classification.When evaluated on three publicly accessible EEG datasets,including those from Boston Children’s Hospital and the Massachusetts Institute of Technology(CHB-MIT)and the Temple University Hospital(TUH)EEG Corpus,the model demonstrated an average accuracy of 98.2%,a sensitivity of 97.8%,a specificity of 98.3%,and an F1-score of 97.9%.Additionally,the inference latency was reduced by approximately 30%compared to standard CNN and Long Short-Term Memory(LSTM)architectures,making it well-suited for real-time applications.The method’s resilience to noise and its adaptability to irregular sampling enhance its potential for clinical use in real-time settings.
基金The authors extend their appreciation to the Distinguished Scientist Fellowship program at King Saud University,Riyadh,Saudi Arabia,for funding this work through Research Supporting Project Number RSP2024R131.
文摘Background:Besides seizures,a myriad of overlapping neuropsychiatric and cognitive comorbidities occur in patients with epilepsy,which further debilitates their quality of life.This study provides an in-depth characterization of the impact of brivaracetam and rufinamide individually and in combination at 10 and 20 mg/kg doses,respec-tively,on corneal kindling-induced generalized seizures and behavioral alterations.Furthermore,observed convulsive frequency and behavioral changes were corre-lated to post-kindling-induced changes in the activity of markers of oxidative stress.Methods:Adult C57BL/6 mice were kindled via twice-daily transcorneal 50-Hz elec-trical stimulations(3 mA)for 3 s for 12 days until animals reached a fully kindled state.After the kindling procedure,animals were tested using a set of behavioral tests,and neurochemical alterations were assessed.Results:Corneal-kindled animals exhibited intense generalized convulsions,altered behavioral phenotypes typified by positive symptoms(hyperlocomotion),negative symptoms(anxiety and anhedonia),and deficits in semantic and working memory.BRV 10+RFM 20 dual regime increased convulsive threshold and propensity toward the start of stage 4–5 seizures and improved phenotypical deficits,that is,anxiety,depression,and memory impairments.Moreover,this combination therapy mitigated kindling-induced redox impairments as evidenced by reduced malondialdehyde and acetylcholinesterase levels and increased glutathione antioxidant activity in the brain of animals subjected to repetitive brain insult.Conclusion:Based on our outcomes,this dual therapy provides supporting evidence in alleviating epilepsy-induced neurobehavioral comorbidities and changes in redox homeostasis.
基金supported by the National Natural Science Foundation Committee of China(81971212,81601129)Shenyang Young and Middle-aged Technological Innovation Talent Support Program(RC210268)Liaoning Province Natural Science Foundation(2023-MS-153).
文摘Epilepsy is a devastating neurological condition that affects over 70 million people worldwide.Apart from idiopathic epilepsy,numerous diseases have been reported to cause secondary epilepsy.Polyphenols,ubiquitously existing in fruits and vegetables,has become a promising neuroprotective candidate against multiple neurological abnormalities due to its interplay with gut microbiome composed of the bacterial population in gastrointestinal system.This bioactive compound is also being tested for the management of epileptogenesis.However,there is still insufficient evidence from mechanistic studies to demonstrate the causal relationship between anti-epileptic effect of polyphenols and microbial alteration.In this review,we provide the brief overview of epilepsy,polyphenols and gut microbiota.We then analysis the association of polyphenols and gut microbiota particularly in the epilepsy and symptomatic seizures-induced by epilepsy related disorders.We also discuss the possibility for the combined application with probiotics to improve the bioavailability and bioaccessibility of polyphenols for expanding its anti-epileptic function.We finally summarize the therapeutic potential of anti-seizure polyphenols through affecting gut microbiome,and propose that the anti-epileptic effect of polyphenols may be tightly relevant to intestinal bacterial flora for overcoming epilepsy and its comorbidities simultaneously.Therefore,the dietary polyphenols targeting specific bacteria may achieve the outcome of‘one stone,two birds’.
基金supported by the Guangdong Basic and Applied Basic Research Foundation,No.2022A1515111123(to JQ)。
文摘Complex genetic architecture is the major cause of heterogeneity in epilepsy,which poses challenges for accurate diagnosis and precise treatment.A large number of epilepsy candidate genes have been identified from clinical studies,particularly with the widespread use of next-generation sequencing.Validating these candidate genes is emerging as a valuable yet challenging task.Drosophila serves as an ideal animal model for validating candidate genes associated with neurogenetic disorders such as epilepsy,due to its rapid reproduction rate,powerful genetic tools,and efficient use of ethological and electrophysiological assays.Here,we systematically summarize the advantageous techniques of the Drosophila model used to investigate epilepsy genes,including genetic tools for manipulating target gene expression,ethological assays for seizure-like behaviors,electrophysiological techniques,and functional imaging for recording neural activity.We then introduce several typical strategies for identifying epilepsy genes and provide new insights into gene-gene interactions in epilepsy with polygenic causes.We summarize well-established precision medicine strategies for epilepsy and discuss prospective treatment options,including drug therapy and gene therapy for genetic epilepsy based on the Drosophila model.Finally,we also address genetic counseling and assisted reproductive technology as potential approaches for the prevention of genetic epilepsy.
基金supported by the URC Aga Khan University(Project ID:212003)Pakistan Science Foundation(Project Code:710110-201-20001-500-53413-0000).
文摘Background:Epilepsy is a disease characterized by unprovoked seizures,and it affects around 70 million people worldwide.Standard treatment is ineffective in one third of all epilepsy patients.Temporal Lobe Epilepsy with Hippocampal Sclerosis(TLE-HS)is the most drug-resistant form of epilepsy,and it also impacts physical,mental,and psychological well-being of patients.Carum carvi extract has demonstrated anti-convulsant,anti-depressant,and anxiolytic properties.This study was designed to investigate if Carum carvi extract can alleviate depression and memory loss symptoms in a TLE-HS animal model.Methods:Male Sprague Dawley rats were used to create a model of TLE-HS and Carum carvi extract treatment,along with appropriate controls,was used to test the efficacy of this herbal extract in reducing the symptoms of depression and memory loss.Results:Forced swim test showed that Carum carvi extract treated TLE-HS rats resulted in significant improvement of the symptoms of depression.However,novel object recognition test showed that memory improvement did not occur.Conclusion:Depression significantly impacts the quality of life in TLE-HS patients,and this study has shown that Carum carvi extract should be explored further as an adjuvant treatment for TLE-HS patients to improve their quality of life.
基金supported by the National Natural Science Foundation of China(82030037)the Translational and Application Project of Brain-inspired and Network Neuroscience on Brain Disorders(11000023T000002036286).
文摘Epilepsy affects over 50 million people worldwide.Drug-resistant epilepsy(DRE)accounts for up to a third of these cases,and neuro-inflammation is thought to play a role in such cases.Despite being a long-debated issue in the field of DRE,the mechanisms underlying neuroinflammation have yet to be fully elucidated.The pro-inflammatory microenvironment within the brain tissue of people with DRE has been probed using single-cell multimodal transcriptomics.Evidence suggests that inflammatory cells and pro-inflammatory cytokines in the nervous system can lead to extensive biochemical changes,such as connexin hemichannel excitability and disruption of neurotransmitter homeostasis.The presence of inflammation may give rise to neuronal network abnormalities that suppress endogenous antiepileptic systems.We focus on the role of neuroinflammation and brain network anomalies in DRE from multiple perspectives to identify critical points for clinical application.We hope to provide an insightful overview to advance the quest for better DRE treatments.
基金supported by grants from the National Key R&D Program of China(2020YFA0803900)the National Natural Science Foundation of China(82173796 and U21A20418)+1 种基金the Natural Science Foundation of Zhejiang Province(LD22H310003)the Key R&D Plan of Zhejiang Province(2021C03116).
文摘Approximately 30%-40% of epilepsy patients do not respond well to adequate anti-seizure medications(ASMs),a condition known as pharmacoresistant epilepsy.The management of pharmacoresistant epilepsy remains an intractable issue in the clinic.Its early prediction is important for prevention and diagnosis.However,it still lacks effective predictors and approaches.Here,a classical model of pharmacoresistant temporal lobe epilepsy(TLE)was established to screen pharmacoresistant and pharmaco-responsive individuals by applying phenytoin to amygdaloid-kindled rats.Ictal electroencephalograms(EEGs)recorded before phenytoin treatment were analyzed.Based on ictal EEGs from pharmacoresistant and pharmaco-responsive rats,a convolutional neural network predictive model was constructed to predict pharmacoresistance,and achieved 78% prediction accuracy.We further found the ictal EEGs from pharmacoresistant rats have a lower gamma-band power,which was verified in seizure EEGs from pharmacoresistant TLE patients.Prospectively,therapies targeting the subiculum in those predicted as“pharmacoresistant”individual rats significantly reduced the subsequent occurrence of pharmacoresistance.These results demonstrate a new methodology to predict whether TLE individuals become resistant to ASMs in a classic pharmacoresistant TLE model.This may be of translational importance for the precise management of pharmacoresistant TLE.
文摘BACKGROUND Epilepsy is a prevalent chronic neurological disorder affecting 50 million individuals globally,with temporal lobe epilepsy(TLE)being the most common form.Despite advances in antiepileptic drug development,over 30%of patients suffer from drug-resistant epilepsy,which can lead to severe cognitive impairments and adverse psychosocial outcomes.AIM To explore the role of bone marrow mesenchymal stem cell(BMSC)-derived exosomal miR-203 in the regulation of neuroinflammation in a mouse model of epilepsy,providing a theoretical basis for the development of targeted microRNA delivery therapies for drug-resistant epilepsy.METHODS Adult male C57BL/6 mice were divided into a control group and a TLE model of 30 mice each,and the TLE model group was established by injecting kainic acid.BMSCs were isolated from the mice,and exosomes were purified using ultracentrifugation.Exosomal miR-203 was identified and characterized using highthroughput sequencing and quantitative reverse-transcription polymerase chain reaction.The uptake of exosomes by hippocampal neurons and the subsequent effects on neuroinflammatory markers were assessed using in vitro cell culture models.RESULTS Exosomal miR-203 exhibited a significant upregulation in BMSCs derived from epileptic mice.In vitro investigations demonstrated the efficient internalization of these exosomes by hippocampal neurons,resulting in downregulation of suppressor of cytokine signaling 3 expression and activation of the nuclear factor kappaB pathway,ultimately leading to enhanced secretion of pro-inflammatory cytokines.CONCLUSION Our study identifies exosomal miR-203 as a key regulator of neuroinflammation in a mouse model of epilepsy.The findings suggest that targeting miR-203 may offer a novel therapeutic strategy for epilepsy by modulating the suppression of cytokine signaling 3/nuclear factor kappaB pathway,thus providing a potential avenue for the development of cell-free therapeutics.
基金supported by the National Natural Science Foundation of China,Nos.82471471(to WJ),82471485(to FY)Shaanxi Province Special Support Program for Leading Talents in Scientific and Technological Innovation,No.tzjhjw(to WJ)+1 种基金Shaanxi Key Research and Development Plan Project,No.2023-YBSF-353(to XW)the Joint Fund Project of Innovation Research Institute of Xijing Hospital,No.LHJJ24JH13(to ZS)。
文摘Epilepsy is a serious neurological disorder;however,the effectiveness of current medications is often suboptimal.Recently,stem cell technology has demonstrated remarkable therapeutic potential in addressing various neurological diseases,igniting interest in its applicability for epilepsy treatment.This comprehensive review summarizes different therapeutic approaches utilizing various types of stem cells.Preclinical experiments have explored the use and potential therapeutic effects of mesenchymal stem cells,including genetically modified variants.Clinical trials involving patientderived mesenchymal stem cells have shown promising results,with reductions in the frequency of epileptic seizures and improvements in neurological,cognitive,and motor functions reported.Another promising therapeutic strategy involves neural stem cells.These cells can be cultured outside the body and directed to differentiate into specific cell types.The transplant of neural stem cells has the potential to replace lost inhibitory interneurons,providing a novel treatment avenue for epilepsy.Embryonic stem cells are characterized by their significant capacity for self-renewal and their ability to differentiate into any type of somatic cell.In epilepsy treatment,embryonic stem cells can serve three primary functions:neuron regeneration,the maintenance of cellular homeostasis,and restorative activity.One notable strategy involves differentiating embryonic stem cells intoγ-aminobutyric acidergic neurons for transplantation into lesion sites.This approach is currently undergoing clinical trials and could be a breakthrough in the treatment of refractory epilepsy.Induced pluripotent stem cells share the same genetic background as the donor,thereby reducing the risk of immune rejection and addressing ethical concerns.However,research on induced pluripotent stem cell therapy remains in the preclinical stage.Despite the promise of stem cell therapies for epilepsy,several limitations must be addressed.Safety concerns persist,including issues such as tumor formation,and the low survival rate of transplanted cells remains a significant challenge.Additionally,the high cost of these treatments may be prohibitive for some patients.In summary,stem cell therapy shows considerable promise in managing epilepsy,but further research is needed to overcome its existing limitations and enhance its clinical applicability.
基金supported by the National Major Scientific and Technological Special Project for Significant New Drugs Development(2019zx09301102)the Project of Liaoning Provincial Department of Education(LJKZ0826)the Open Project of National and Local Joint Engineering Research Center for Drug Research and Development of Neurodegenerative Diseases(2022GCYJZX-YB02).
文摘Neuroinflammation mediated by microglia and oxidative stress play pivotal roles in the development of chronic temporal lobe epilepsy(TLE).We postulated that kainic acid(KA)-Induced status epilepticus triggers microglia-dependent inflammation,leading to neuronal damage,a lowered seizure threshold,and the emergence of spontaneous recurrent seizures(SRS).Extensive evidence from our laboratory suggests that dextromethorphan(DM),even in ultra-low doses,has anti-inflammatory and neuroprotective effects in many animal models of neurodegenerative disease.Our results showed that administration of DM(10 ng/kg per day;subcutaneously via osmotic minipump for 4 weeks)significantly mitigated the residual effects of KA,including the frequency of SRS and seizure susceptibility.In addition,DM-treated rats showed improved cognitive function and reduced hippocampal neuronal loss.We found suppressed microglial activation-mediated neuroinflammation and decreased expression of hippocampal gp91^(phox) and p47^(phox) proteins in KA-induced chronic TLE rats.Notably,even after discontinuation of DM treatment,ultra-low doses of DM continued to confer long-term anti-seizure and neuroprotective effects,which were attributed to the inhibition of microglial NADPH oxidase 2 as revealed by mechanistic studies.
基金supported by STI2030-Major Projects,No.2022ZD0207600 (to LZ)the National Natural Science Foundation of China,Nos.821 71446 (to JY),U22A20301 (to KFS),32070955 (to LZ)+1 种基金Guangdong Basic and Applied Basic Research Foundation,No.202381515040015 (to LZ)Science and Technology Program of Guangzhou of China,No.202007030012 (to KFS and LZ)
文摘Epilepsy frequently leads to cognitive dysfunction and approaches to treatment remain limited.Although regular exercise effectively improves learning and memory functions across multiple neurological diseases,its application in patients with epilepsy remains controversial.Here,we adopted a 14-day treadmill-exercise paradigm in a pilocarpine injection-induced mouse model of epilepsy.Cognitive assays confirmed the improvement of object and spatial memory after endurance training,and electrophysiological studies revealed the maintenance of hippocampal plasticity as a result of physical exercise.Investigations of the mechanisms underlying this effect revealed that exercise protected parvalbumin interneurons,probably via the suppression of neuroinflammation and improved integrity of blood-brain barrier.In summary,this work identified a previously unknown mechanism through which exercise improves cognitive rehabilitation in epilepsy.
基金supported by funding from the High-level New R&D Institute(2019B090904008)the High-level Innovative Research Institute(2021B0909050003)of the Department of Science and Technology of Guangdong Province+4 种基金National Science and Technology Innovation 2030 Major Program(2021ZD0200900)Shanghai Municipal Science and Technology Major Project(2018SHZDZX05)Zhongshan Municipal Bureau of Science and Technology(CXTD2022013)the National Science Fund for Distinguished Young Scholars(81825021)the funding from Zhongshan Municipal Bureau of Science and Technology(210724194041939).
文摘Epilepsy is a common neurological disorder that is primarily treated with antiseizure medications(ASMs).Although dozens of ASMs are available in the clinic,approximately 30%of epileptic patients have medically refractory seizures;other limitations in most traditional ASMs include poor tolerability and drug-drug interactions.Therefore,there is an urgent need to develop alternative ASMs.Levetiracetam(LEV)is a first-line ASM that is well tolerated,has promising efficacy,and has little drug-drug interaction.Although it is widely accepted that LEV acts through a unique therapeutic target synaptic vesicle protein(SV)2A,the molecular basis of its action remains unknown.Even so,the next-generation SV2A ligands against epilepsy based on the structure of LEV have achieved clinical success.This review highlights the research and development(R&D)process of LEV and its analogs,brivaracetam and padsevonil,to provide ideas and experience for the R&D of novel ASMs.
